Influence of ursodeoxycholic acid on the mortality and malignancy associated with primary biliary cirrhosis: A population-based cohort study

Authors

  • Hannah Jackson,

    1. University of Nottingham Medical School, Division of Epidemiology and Public Health, Medical School, Queen's Medical Centre, Nottingham, United Kingdom
    Search for more papers by this author
  • Masoud Solaymani-Dodaran,

    1. University of Nottingham Medical School, Division of Epidemiology and Public Health, Medical School, Queen's Medical Centre, Nottingham, United Kingdom
    Search for more papers by this author
  • Tim R. Card,

    1. University of Nottingham Medical School, Division of Epidemiology and Public Health, Medical School, Queen's Medical Centre, Nottingham, United Kingdom
    Search for more papers by this author
  • Guruprasad P. Aithal,

    1. Wolfson Digestive Diseases Centre, Medical School, Queen's Medical Centre, Nottingham, UK
    Search for more papers by this author
  • Richard Logan,

    1. University of Nottingham Medical School, Division of Epidemiology and Public Health, Medical School, Queen's Medical Centre, Nottingham, United Kingdom
    Search for more papers by this author
  • Joe West

    Corresponding author
    1. University of Nottingham Medical School, Division of Epidemiology and Public Health, Medical School, Queen's Medical Centre, Nottingham, United Kingdom
    • University of Nottingham, Division of Epidemiology and Public Health, Queen's Medical Centre, Nottingham, UK, NG7 2UH
    Search for more papers by this author
    • fax: (44)-0-115-8230464


  • Potential conflict of interest: Nothing to report.

Abstract

There is debate over the mortality and malignancy risk in people with primary biliary cirrhosis (PBC) and whether this risk is reduced by use of ursodeoxycholic acid. To investigate this issue, we identified 930 people with PBC and 9,202 control subjects from the General Practice Research Database in the United Kingdom. We categorized regular ursodeoxycholic acid as treatment with 6 or more prescriptions and nonregular treatment as less than 6. We found a 2.7-fold increase in mortality for the PBC cohort compared with the general population [adjusted hazard ratio (HR), 2.69; 95% CI, 2.35–3.09]. In those having regular ursodeoxycholic acid (43%), the mortality increase was 2.2-fold (HR, 2.19; 95% CI, 1.66–2.87) and in those not treated 2.7-fold (HR, 2.69; 95% CI, 2.18–3.33). This apparent reduction in mortality was not explained by less severe disease in the ursodeoxycholic acid–treated group. The increased risk of primary liver cancer in ursodeoxycholic acid–treated patients was 3-fold (HR, 3.17; 95% CI, 0.64–15.62), in contrast to an 8-fold increase in those not treated (HR, 7.77; 95% CI, 1.30–46.65). Conclusion: We found that people with PBC had a 3-fold mortality increase when compared with the general population, which was somewhat reduced by regular treatment with ursodeoxycholic acid. However, the observed effect of ursodeoxycholic acid was not statistically significant. (HEPATOLOGY 2007.)

Ancillary