A Prospective Randomized Controlled Study of Long-Term Combination Therapy Using Ursodeoxycholic Acid and Bezafibrate in Patients With Primary Biliary Cirrhosis and Dyslipidemia

Kenichi Hosonuma MD, PhD¹, Ken Sato MD, PhD², Yuichi Yamazaki MD, PhD², Masatoshi Yanagisawa MD³, Hiroaki Hashizume MD, PhD², Norio Horiguchi MD, PhD², Satoru Kakizaki MD, PhD², Motoyasu Kusano MD, PhD⁴and Masanobu Yamada MD, PhD²

OBJECTIVES:

The aim of this study was to assess the long-term prognosis, efficacy, and safety of combination therapy using ursodeoxycholic acid (UDCA) and bezafibrate (BF) for primary biliary cirrhosis (PBC) patients exhibiting dyslipidemia.

METHODS:

We performed a prospective, randomized, controlled, multicenter study to compare the long-term clinical results between combination therapy and UDCA monotherapy for patients refractory to UDCA monotherapy. Twenty-seven consecutive PBC patients were enrolled.

RESULTS:

The median treatment period in the UDCA and UDCA+BF groups was 107 and 110 months, respectively. The serum alkaline phosphatase (ALP) levels and the Mayo risk score in the combination therapy group (mean 290IU/l and 0.91, respectively) were significantly lower than those in the UDCA monotherapy group (mean 461IU/l and 1.42, respectively) at 8 years after the beginning of the study (P<0.05). The serum creatinine levels in the combination therapy group (mean 0.94mg/dl) were significantly higher than those in the UDCA monotherapy group (mean 0.56mg/dl) at 8 years after the beginning of the study (P<0.05). However, the survival rate was not significantly different between the groups. We observed dose reduction or discontinuation of the administration of BF, but not UDCA, due to renal dysfunction or muscle pain.

CONCLUSIONS:

Long-term combination therapy significantly improved the serum ALP levels and the Mayo risk score. However, the survival rate was not significantly different between the groups. In addition, long-term combination therapy significantly increased the serum creatinine levels. We should pay close attention to adverse events during this long-term combination therapy.

Am J Gastroenterol2015; 110:423–431; doi:10.1038/ajg.2015.20; published online 3 March 2015