A randomized controlled trial of ursodeoxycholic acid in patients with alcohol-induced cirrhosis and jaundice.
The aim of our multicenter study was to assess the efficacy of ursodeoxycholic acid (UDCA) on the survival of patients with alcohol-induced cirrhosis and jaundice. We included patients with histologically proven alcohol-induced cirrhosis and serum bilirubin >50 micromol/L. After randomization, patients received either UDCA (13-15 mg/kg/d) or a placebo for 6 months. Two hundred twenty-six patients (113 in each group) were included in 24 centers. There were 139 men and 87 women, mean age of 50.3 years. Seventy-four percent had associated alcohol-induced hepatitis, and 24% received a corticosteroid therapy. At inclusion, the 2 groups were comparable for the main clinical and biologic parameters, but serum bilirubin was higher in the UDCA group than in the placebo group (163 micromol/L vs. 145 micromol/L, P <.03). The percentage of patients lost at follow-up or who resumed their alcoholism during the study was comparable in the 2 groups. During the study, 55 patients died, 35 in the UDCA group and 20 in the placebo group. In the intention to treat analysis, the probability of survival at 6 months (Kaplan-Meier method) was lower in the UDCA than in the P group (69% vs. 82%, respectively; P =.04, log-rank test). After adjustment on the bilirubin level at entry (Cox model), the independent predictive value of the treatment group did not reach the statistical level (RR = 1.64, CI 0.85-2.85; P =.077). In conclusion, UDCA administered at the dose recommended in primary biliary cirrhosis has no beneficial effect on the 6-month survival of patients with severe alcohol-induced cirrhosis. An inappropriate dosage of UDCA cannot be excluded as an explanation for the lack of therapeutic benefit.
Pelletier
Gilles
G
Department of Gastroenterology of Hôpital Bicêtre, Assistance Publique-Hôopitaux de Paris, Paris, France.
Roulot
Dominique
D
Davion
Thierry
T
Masliah
Claude
C
Causse
Xavier
X
Oberti
Frédéric
F
Raabe
Jean-Jacques
JJ
Van Lemmens
Claire
C
Labadie
Hélène
H
Serfaty
Lawrence
L
D000328:Adult; D000368:Aged; D001647:Bile Acids and Salts / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007565:Jaundice / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010919:Placebos / Q000627:therapeutic use; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome; D014580:Ursodeoxycholic Acid / Q000009:adverse effects / Q000627:therapeutic use*
D001647:Bile Acids and Salts; D010919:Placebos; D014580:Ursodeoxycholic Acid