title: Ursodeoxycholic acid in the treatment of primary biliary cirrhosis.
abstract: OBJECTIVE
  A double-blind, placebo-controlled trial of ursodeoxycholic acid (UDCA) was conducted in 180 patients with primary biliary cirrhosis (PBC) to define the efficacy and safety of UDCA. Efficacy was assessed by time to treatment failure defined as death; liver transplantation; histological progression; development of varices, ascites, or encephalopathy; doubling of total serum bilirubin levels; progression of fatigue or pruritus; drug toxicity; or voluntary withdrawal.
  
  
  METHODS
  Patients with well-defined PBC underwent complete history, physical examination, liver chemistries, ultrasonography, upper endoscopy, and liver biopsy at entry as well as at 2 years. Liver chemistries were determined every 3 months.
  
  
  RESULTS
  In patients receiving UDCA, treatment failure was delayed compared with the placebo-treated group (P = 0.0003, log rank test). Seven patients receiving UDCA died or required transplantation compared with 12 in the placebo group (P = 0.18). No patients discontinued UDCA because of side effects of toxicity.
  
  
  CONCLUSIONS
  UDCA was extraordinarily safe and well tolerated, and its use was associated with delayed progression of the disease as defined in this study. However, the lack of effects on symptoms, histology, and the need for liver transplantation or survival indicate that further evaluation is necessary to determine the ultimate role of UDCA in the treatment of PBC.
authors.affiliation: Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota.
authors.forename: K D
authors.initials: KD
authors.lastname: Lindor
authors.forename: E R
authors.initials: ER
authors.lastname: Dickson
authors.forename: W P
authors.initials: WP
authors.lastname: Baldus
authors.forename: R A
authors.initials: RA
authors.lastname: Jorgensen
authors.forename: J
authors.initials: J
authors.lastname: Ludwig
authors.forename: P A
authors.initials: PA
authors.lastname: Murtaugh
authors.forename: J M
authors.initials: JM
authors.lastname: Harrison
authors.forename: R H
authors.initials: RH
authors.lastname: Wiesner
authors.forename: M L
authors.initials: ML
authors.lastname: Anderson
authors.forename: S M
authors.initials: SM
authors.lastname: Lange
mesh_terms: D000328:Adult; D001663:Bilirubin / Q000097:blood; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008105:Liver Cirrhosis, Biliary / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D014580:Ursodeoxycholic Acid / Q000592:standards / Q000627:therapeutic use*
chemical_list: D014580:Ursodeoxycholic Acid; D001663:Bilirubin