title: Combined treatment with ursodeoxycholic acid and prednisone in primary biliary cirrhosis.
abstract: OBJECTIVE
  To assess the effect of combined therapy (CT) of ursodeoxycholic acid (UDCA) with prednisone on symptoms and biochemistry in patients with non-advanced primary biliary cirrhosis (PBC), who had responded insufficiently to either drug alone.
  
  
  METHODS
  Retrospective evaluation of the effect of 1 year of CT on symptoms (pruritus, fatigue, arthralgia) and biochemical parameters [bilirubin, alkaline phosphatase (APh), aspartate aminotransferase (AST) and IgM] in 7 symptomatic patients.
  
  
  RESULTS
  Five of the 7 patients became asymptomatic. Pruritus disappeared in 2 of 3 patients, fatigue in 4 of 6 and arthralgia in both symptomatic patients. APh and AST decreased in all patients (median 41% and 59%, respectively). IgM decreased, although to a lesser degree (median 16%), in all but 1 patient. Normal levels for AST were achieved in 4 patients. In 2 of these APh normalized too. In 2 patients IgM became normal. Bilirubin, only slightly elevated in 1 patient, remained stable in all. The beneficial effects were maintained during follow-up (median 1.5 years). The treatment was well tolerated by all patients.
  
  
  CONCLUSIONS
  In PBC, combined treatment with UDCA and prednisone appears to improve symptoms and biochemical parameters to a larger extent than either treatment alone; randomized controlled trials should be performed to establish the benefit/risk ratio of this combination therapy.
authors.affiliation: Department of Internal Medicine II (Section of Hepatology), University Hospital Dijkzigt, Rotterdam, Netherlands.
authors.forename: F H
authors.initials: FH
authors.lastname: Wolfhagen
authors.forename: H R
authors.initials: HR
authors.lastname: van Buuren
authors.forename: S W
authors.initials: SW
authors.lastname: Schalm
mesh_terms: D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007165:Immunosuppression Therapy; D007249:Inflammation; D008105:Liver Cirrhosis, Biliary / Q000097:blood / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use*
chemical_list: D007075:Immunoglobulin M; D014580:Ursodeoxycholic Acid; D001219:Aspartate Aminotransferases; D000469:Alkaline Phosphatase; D001663:Bilirubin; D011241:Prednisone