title: The efficacy of ursodeoxycholic acid and bezafibrate combination therapy for primary biliary cirrhosis: A prospective, multicenter study.
abstract: OBJECTIVE
  Treatment with ursodeoxycholic acid (UDCA) improves the survival of stage I and II primary biliary cirrhosis (PBC) patients. However, new therapeutic options are needed for patients who are refractory to UDCA and for those whose disease is at an advanced stage. Bezafibrate could be useful in PBC treatment, since it increases phospholipid output into the bile and reduces the cytotoxicity of hydrophobic bile acids, which are increased with cholestasis.
  
  
  METHODS
  We conducted two prospective, multicenter randomized open studies in non-cirrhotic patients with PBC to evaluate the efficacy of bezafibrate. One study compared UDCA and bezafibrate monotherapy (study 1: 45 patients [37 females], mean age 55.9 years), and the other evaluated the addition of bezafibrate to patients who were refractory to UDCA (study 2: 21 patients [18 females], mean age 54.1 years).
  
  
  RESULTS
  Study 1 demonstrated that bezafibrate monotherapy was as effective as UDCA and study 2 revealed that bezafibrate combined with UDCA was effective in improving and maintaining biliary enzymes where the ineffectiveness of long-term treatment with UDCA was confirmed.
  
  
  CONCLUSIONS
  This multicenter, randomized, open study revealed that combination therapy of bezafibrate and UDCA improved biliary enzymes in non-cirrhotic Japanese patients with PBC refractory to UDCA. Further studies are needed to evaluate whether combination therapy improves histological staging and prognosis.
authors.affiliation: Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Iwasaki
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Ohira
authors.forename: Shuhei
authors.initials: S
authors.lastname: Nishiguchi
authors.forename: Mikio
authors.initials: M
authors.lastname: Zeniya
authors.forename: Shuichi
authors.initials: S
authors.lastname: Kaneko
authors.forename: Morikazu
authors.initials: M
authors.lastname: Onji
authors.forename: Hiromi
authors.initials: H
authors.lastname: Ishibashi
authors.forename: Isao
authors.initials: I
authors.lastname: Sakaida
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kuriyama
authors.forename: Takafumi
authors.initials: T
authors.lastname: Ichida
authors.forename: Saburo
authors.initials: S
authors.lastname: Onishi
authors.forename: Gotaro
authors.initials: G
authors.lastname: Toda