title: Sustained biochemical and histologic remission of primary biliary cirrhosis in response to medical treatment.
abstract: BACKGROUND
  Treatment of primary biliary cirrhosis with ursodiol or colchicine may stabilize the disease or slow its rate of progression, but no reports of spontaneous or treatment-related remission have been published.
  
  
  OBJECTIVE
  To determine whether primary biliary cirrhosis fully responds to low-dose oral methotrexate therapy.
  
  
  METHODS
  Prospective case study with at least 6 years of observation.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  5 of 19 patients with biopsy-proven precirrhotic primary biliary cirrhosis who had been ill for at least 1 year. Three of the 5 had not responded to colchicine or had responded only partially.
  
  
  METHODS
  Oral methotrexate, 15 mg/wk in divided doses.
  
  
  METHODS
  Symptoms, biochemical tests of liver function, and percutaneous liver biopsies. The latter were done at baseline, 1 to 2 years after initiation of methotrexate therapy, and then every 2 to 3 years during methotrexate therapy.
  
  
  RESULTS
  All 5 patients completely responded to medical treatment. Results of biochemical tests of liver function, became normal, symptoms remitted, and serial liver biopsy specimens showed progressive histologic improvement. Biopsy specimens obtained after 5 to 12 years of treatment showed few signs of primary biliary cirrhosis and, in 3 patients, were close to normal. Five of the other 14 patients have responded biochemically and have shown histologic improvement; the other 9 have not responded to methotrexate therapy, have discontinued therapy, or have been lost to follow-up.
  
  
  CONCLUSIONS
  In some patients, primary biliary cirrhosis may remit in response to methotrexate alone or in combination with colchicine or ursodiol.
authors.affiliation: New England Medical Center, Boston, Massachusetts, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Kaplan
authors.forename: R A
authors.initials: RA
authors.lastname: DeLellis
authors.forename: H J
authors.initials: HJ
authors.lastname: Wolfe
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D002756:Cholagogues and Choleretics / Q000627:therapeutic use*; D003078:Colchicine / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D011446:Prospective Studies; D012074:Remission Induction; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
chemical_list: D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase; D001663:Bilirubin; D003078:Colchicine; D008727:Methotrexate