title: Old and novel therapies for primary biliary cirrhosis.
abstract: Despite the presumed immunological pathogenesis of primary biliary cirrhosis, no clear or even harmful consequences resulted from some specific treatments addressed to modify the immunological condition. However, ursodeoxycholic acid (UDCA; 13-16 mg/kg/d) has clear favorable effects not only by improving biochemical cholestasis, but also by delaying the histological progression. Long -term treatment with UDCA is associated with excellent survival, free of transplantation in cases showing biochemical response at one year. In the remaining patients, data on the effect of fibrates, budesonide, or obeticholic acid are encouraging. Pruritus is usually managed using resins; further steps are needed in resistant cases with the use of rifampicin, naltrexone, sertraline, or invasive procedures such as albumin dialysis. Osteoporosis, which is highly prevalent in patients with deep and prolonged cholestasis, improves with bisphosphonates; current data indicate that both weekly alendronate and monthly ibandronate increase bone mass in patients with osteoporosis. Nutritional and fat-vitamin supplementation is also mandatory in patients with severe cholestasis.
authors: Department of Medicine, University of Barcelona, Liver Unit, Hospital Clínic, IDIBAPS,CIBERehd, Barcelona, Spain.
authors: Albert
authors: A
authors: Parés
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000982:Antipruritics / Q000627:therapeutic use; D001653:Bile Ducts, Intrahepatic / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D019587:Dietary Supplements; D004359:Drug Therapy, Combination; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D016031:Liver Transplantation; D010024:Osteoporosis / Q000188:drug therapy / Q000209:etiology; D011537:Pruritus / Q000188:drug therapy / Q000209:etiology; D016896:Treatment Outcome; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
chemical_list: D000893:Anti-Inflammatory Agents; D000982:Antipruritics; D050071:Bone Density Conservation Agents; D002756:Cholagogues and Choleretics; D005765:Gastrointestinal Agents; D014580:Ursodeoxycholic Acid