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Gómez E, Montero JL, Molina E, García-Buey L, Casado M, Fuentes J, Simón MA, Díaz-González A, Jorquera F, Morillas RM, Presa J, Berenguer M, Conde MI, Olveira A, Macedo G, Garrido I, Hernández-Guerra M, Olivas I, Rodríguez-Taje S, Londoño M, Sousa JM, Ampuero J, Romero-González E, González-Padilla S, Escudero-García D, Carvalho A, Santos A, Gutiérrez ML, Pérez-Fernández E, Aburruza L, Uriz J, Gomes D, Santos L, Martínez-González J, Albillos A, Fernández-Rodríguez CM. Longitudinal outcomes of obeticholic acid therapy in ursodiol-nonresponsive primary biliary cholangitis: Stratifying the impact of add-on fibrates in real-world practice. Aliment Pharmacol Ther 2024. [PMID: 38690746 DOI: 10.1111/apt.18004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/06/2024] [Accepted: 04/07/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Suboptimal response to ursodeoxycholic acid occurs in 40% of primary biliary cholangitis (PBC) patients, affecting survival. Achieving a deep response (normalisation of alkaline phosphatase [ALP] and bilirubin ≤0.6 upper limit of normal) improves survival. Yet, the long-term effectiveness of second-line treatments remains uncertain. AIMS To evaluate the long-term effectiveness of obeticholic acid (OCA) ± fibrates. Focusing on biochemical response (ALP ≤1.67 times the upper limit of normal, with a decrease of at least 15% from baseline and normal bilirubin levels), normalisation of ALP, deep response and biochemical remission (deep response plus aminotransferase normalisation). METHODS We conducted a longitudinal, observational, multicentre study involving ursodeoxyccholic acid non-responsive PBC patients (Paris-II criteria) from Spain and Portugal who received OCA ± fibrates. RESULTS Of 255 patients, median follow-up was 35.1 months (IQR: 20.2-53). The biochemical response in the whole cohort was 47.2%, 61.4% and 68.6% at 12, 24 and 36 months. GLOBE-PBC and 5-year UK-PBC scores improved (p < 0.001). Triple therapy (ursodeoxycholic acid plus OCA plus fibrates) had significantly higher response rates than dual therapy (p = 0.001), including ALP normalisation, deep response and biochemical remission (p < 0.001). In multivariate analysis, triple therapy remained independently associated with biochemical response (p = 0.024), alkaline phosphatase normalisation, deep response and biochemical remission (p < 0.001). Adverse effects occurred in 41.2% of cases, leading to 18.8% discontinuing OCA. Out of 55 patients with cirrhosis, 12 developed decompensation. All with baseline portal hypertension. CONCLUSION Triple therapy was superior in achieving therapeutic goals in UDCA-nonresponsive PBC. Decompensation was linked to pre-existing portal hypertension.
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Affiliation(s)
- E Gómez
- Hospital Universitario 12 De Octubre, Madrid, Spain
| | - J L Montero
- Hospital Universitario Reina Sofia, Córdoba, Spain
| | - E Molina
- Complexo Hospitalario Universitario De Santiago, Coruña, Spain
| | - L García-Buey
- Hospital Universitario De La Princesa, Madrid, Spain
| | - M Casado
- Hospital Universitario de Torrecárdenas, Almería, Spain
| | - J Fuentes
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - M A Simón
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- University of Zaragoza, Zaragoza, Spain
| | - A Díaz-González
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - F Jorquera
- Complejo Hospitalario de Leon, Leon, Spain
| | | | - J Presa
- Centro Hospitalar Tras-os-Montes a Alto Douro, Vila Real, Portugal
| | - M Berenguer
- Hospital Universitario La Fe, Valencia, Spain
- University of Valencia, Valencia, Spain
| | - M I Conde
- Hospital Universitario La Fe, Valencia, Spain
| | - A Olveira
- Hospital Universitario La Paz, Madrid, Spain
| | - G Macedo
- Serviço de Gastrenterologia Do Centro Hospitalar Universitário São João (CHUSJ), Porto, Portugal
| | - I Garrido
- Serviço de Gastrenterologia Do Centro Hospitalar Universitário São João (CHUSJ), Porto, Portugal
| | | | - I Olivas
- Hospital Clinic, Barcelona, Spain
| | | | | | - J M Sousa
- Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - J Ampuero
- Hospital Universitario Virgen del Rocio, Sevilla, Spain
- Instituto De Biomedicina De Sevilla (IBIS), Sevilla, Spain
| | - E Romero-González
- Hospital Clinico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Sh González-Padilla
- Hospital Clinico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - D Escudero-García
- Hospital Clinico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - A Carvalho
- Centro Hospitalar e Universitário De Coimbra, Coimbra, Portugal
| | - A Santos
- Centro Hospitalar e Universitário De Coimbra, Coimbra, Portugal
| | - M L Gutiérrez
- Hospital Universitario Fundacion Alcorcon, Alcorcon Madrid, Spain
- University Rey Juan Carlos, Madrid, Spain
| | - E Pérez-Fernández
- Hospital Universitario Fundacion Alcorcon, Alcorcon Madrid, Spain
- University Rey Juan Carlos, Madrid, Spain
| | - L Aburruza
- Hospital Universitario de Donostia, Donostia-San Sebastián, Spain
| | - J Uriz
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | - D Gomes
- Departamento de Gastrenterología, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - L Santos
- Departamento de Gastrenterología, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | | | - A Albillos
- Hospital Universitario Ramón y Cajal, Madrid, Spain
- Ramón y Cajal Institute of Health Research, Madrid, Spain
- University of Alcalá de Henares, Alcalá de Henares, Spain
| | - C M Fernández-Rodríguez
- Hospital Universitario Fundacion Alcorcon, Alcorcon Madrid, Spain
- University Rey Juan Carlos, Madrid, Spain
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Davis González MR, Ballester MP, Romero-González E, Sánchez-Pardo AM, Marti-Aguado D, Tosca J, Suria C, Antón Ausejo R, Pascual Moreno I, Planelles Silvestre MD, Mínguez Pérez M, Bosca-Watts MM. Biological treatment interruption in inflammatory bowel disease: Motivation and predictive factors. Gastroenterol Hepatol 2023; 46:671-681. [PMID: 36375696 DOI: 10.1016/j.gastrohep.2022.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Loss-of-response and adverse events (AE) to biologics have been linked to HLA-DQA1*05 allele. However, the clinical factors or biologic used may influence treatment duration. Our objective was to evaluate the influence of clinical and therapeutic factors, along with HLA, in biological treatment discontinuation. METHODS A retrospective study of consecutive IBD patients treated with biologics between 2007 and 2011 was performed. Main outcome was treatment discontinuation due to primary non-response (PNR), secondary loss of response (SLR) or AE. HLA-DQA1 genotyping was done in all patients. Regression analyses were used to assess risk factors of treatment discontinuation. RESULTS One hundred fifty patients (61% male) with 312 biologic treatments were included. 147 (47%) were discontinued with a cumulative probability of 30%, 41% and 56% at 1, 2 and 5 years. The use of infliximab (p=0.006) and articular manifestations (p<0.05) were associated with treatment discontinuation. Considering cause of withdrawal, Ulcerative Colitis (UC) had a higher proportion of PNR (HR=4.99; 95% CI=1.71-14.63; p=0.003), SLR was higher if biologics had been indicated due to disease flare (HR=2.32; 95% CI=1.05-5.09; p=0.037) while AE were greater with infliximab (HR=2.46; 95% CI=1.48-4.08; p<0.001) or spondylitis (HR=2.46; 95% CI=1.78-6.89; p<0.001). According to the biological drug, HLA-DQA1*05 with adalimumab showed more SLR in cases with Crohn's disease (HR=3.49; 95% CI=1.39-8,78; p=0.008) or without concomitant immunomodulator (HR=2.8; 95% CI=1.1-6.93; p=0.026). CONCLUSIONS HLA-DQ A1*05 was relevant in SLR of IBD patients treated with adalimumab without immunosupression. In patients treated with other biologics, clinical factors were more important for treatment interruption, mainly extensive UC or extraintestinal manifestations and having indicated the biologic for flare.
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Affiliation(s)
- María Rocío Davis González
- IBD Unit, Digestive Disease Medicine, University of Valencia, University Clinic Hospital of Valencia, Spain
| | - María Pilar Ballester
- IBD Unit, Digestive Disease Medicine, University of Valencia, University Clinic Hospital of Valencia, Spain; Instituto de Investigación Sanitaria INCLIVA, Spain.
| | - Eva Romero-González
- IBD Unit, Digestive Disease Medicine, University of Valencia, University Clinic Hospital of Valencia, Spain
| | - Ana María Sánchez-Pardo
- IBD Unit, Digestive Disease Medicine, University of Valencia, University Clinic Hospital of Valencia, Spain
| | - David Marti-Aguado
- IBD Unit, Digestive Disease Medicine, University of Valencia, University Clinic Hospital of Valencia, Spain
| | - Joan Tosca
- IBD Unit, Digestive Disease Medicine, University of Valencia, University Clinic Hospital of Valencia, Spain
| | - Carles Suria
- IBD Unit, Digestive Disease Medicine, University of Valencia, University Clinic Hospital of Valencia, Spain
| | - Rosario Antón Ausejo
- IBD Unit, Digestive Disease Medicine, University of Valencia, University Clinic Hospital of Valencia, Spain
| | - Isabel Pascual Moreno
- IBD Unit, Digestive Disease Medicine, University of Valencia, University Clinic Hospital of Valencia, Spain
| | | | - Miguel Mínguez Pérez
- IBD Unit, Digestive Disease Medicine, University of Valencia, University Clinic Hospital of Valencia, Spain
| | - Marta Maia Bosca-Watts
- IBD Unit, Digestive Disease Medicine, University of Valencia, University Clinic Hospital of Valencia, Spain
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Rodríguez-Capitán J, Fernández-Meseguer A, Romero-González E, Calvo-Bonacho E, Gómez-Doblas JJ, de Teresa-Galván E. Frequency of Atrial Fibrillation in a Large Sample of Young Adults Selected From the Spanish Working Population. Rev Esp Cardiol (Engl Ed) 2018; 71:498-500. [PMID: 28528888 DOI: 10.1016/j.rec.2017.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/09/2017] [Indexed: 06/07/2023]
Affiliation(s)
| | | | - Eva Romero-González
- Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain
| | - Eva Calvo-Bonacho
- Ibermutuamur, Mutua Colaboradora con la Seguridad Social, Madrid, Spain
| | - Juan José Gómez-Doblas
- Unidad de Gestión Clínica del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Instituto Biosanitario de Málaga. (IBIMA), CIBER de Enfermedades Cardiovasculares, Universidad de Málaga, Málaga, Spain
| | - Eduardo de Teresa-Galván
- Unidad de Gestión Clínica del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Instituto Biosanitario de Málaga. (IBIMA), CIBER de Enfermedades Cardiovasculares, Universidad de Málaga, Málaga, Spain
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