Combination of fibrates with obeticholic acid is able to normalise biochemical liver tests in patients with difficult?to?treat primary biliary cholangitis

Background Obeticholic acid (OCA) and fibrates are second-line therapies for patients with primary biliary cholangitis (PBC) an inadequate response to ursodeoxycholic (UDCA). Aim To know whether OCA fibrates, administered together in combination UDCA, have additive beneficial effects difficult-to-treat PBC. Methods PBC treated ?3 months (bezafibrate or fenofibrate) due failure of either therapy were included a multicentre, uncontrolled retrospective cohort study. Changes biochemical liver tests pruritus analysed using generalised linear mixed-effect model. Results Among 58 included, half received as third-line (Group OCA-Fibrate), while the other had inverse therapeutic sequence Fibrate-OCA). The mean duration triple was 11 (range 3-26). Compared dual therapy, associated significant gain alkaline phosphatase (ALP) reduction: 22% per first year (95% CI 12%-31%), effect that stronger OCA-Fibrate than Fibrate-OCA group. Triple 3.4 1.4-8.2) odds ratio (OR) reaching normal ALP decrease gamma-glutamyl transpeptidase (GGT), alanine aminotransferase (ALT), aspartate (AST) total bilirubin. ORs achieving Paris-2 Toronto criteria adequate 6.8 2.8-16.7) 9.2 3.4-25.1) respectively. Finally, significantly improved but not Conclusions is able normalise improve