Impact of Obeticholic acid Exposure on Decompensation and Mortality in Primary Biliary Cholangitis and Cirrhosis. Issue 8 (6th May 2021)

• Record Type: Journal Article
• Authors: John, Binu V.; Schwartz, Kaley; Levy, Cynthia; Dahman, Bassam; Deng, Yangyang; Martin, Paul; Taddei, Tamar H.; Kaplan, David E.
• Is Part Of: Hepatology communications. Volume 5:Issue 8(2021)
• Page Start: 1426
• Page End: 1436
• Publication Date: 2021-05-06
• Subjects: Hepatology -- Periodicals; Liver -- Diseases -- Periodicals; Liver Diseases; Gastroenterology; Periodicals; Fulltext; Internet Resources; Periodicals; 616.36
• DOI: 10.1002/hep4.1720
• Languages: English
• ISSNs: 2471-254X

Abstract

Abstract : Obeticholic acid (OCA) is approved for the treatment of patients with primary biliary cholangitis (PBC) who are partial responders or intolerant to ursodeoxycholic acid. Reports of serious liver injury have raised concerns about its safety in cirrhosis. We investigated the effects of treatment with OCA on hepatic decompensation and liver‐related mortality or transplantation in a cohort with compensated PBC cirrhosis. This was a retrospective cohort study using national data of US veterans with PBC and cirrhosis. We performed a propensity score model using variables associated with OCA prescription to control for baseline risk of decompensation. New OCA users were matched to nonusers. We identified 509 subjects with compensated PBC cirrhosis. We developed a propensity score model using variables associated with OCA prescription; 21 OCA users were matched with 84 nonusers. Over 569 and 3, 847 person‐months, respectively, of follow‐up, 5 (23.8%) OCA users and 22 (26.2%) OCA nonusers decompensated. The C‐statistic of the propensity score model was 0.87. On multivariable analysis, after adjusting for potential confounders, OCA use was associated with an increased risk of hepatic decompensation (adjusted hazard ratio, 3.9; 95% confidence interval, 1.33‐11.57; P = 0.01). There was no association between OCA use and liver‐related mortality or transplantation (adjusted hazard ratio, 1.35; 95% confidence interval, 0.35‐5.21; P = 0.66). Conclusion: OCA use was associated with an increase in hepatic decompensation but not liver‐related mortality or transplantation in patients with compensated PBC cirrhosis. Additional studies are recommended to prospectively investigate these findings. Abstract : Our data suggest that exposure to OCA in patients with PBC cirrhosis is associated with a 3.9‐fold higher risk of hepatic decompensation compared with a propensity‐matched cohort of PBC cirrhosis with similar baseline risk. Large, prospective studies are needed to confirm our findings. Our findings raise concerns about OCA, and we recommend that clinicians be cautious about using this drug, even in patients with well‐compensated cirrhosis, until we establish safety from ongoing trials.image