Methotrexate in Patients with Primary Biliary Cirrhosis Who Respond Incompletely to Treatment With Ursodeoxycholic Acid
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Approximately 35% of PBC patients have progressive disease despite treatment with UDCA.
We offered treatment with methotrexate and colchicine to PBC patients who had not responded fully to UDCA, after at least 1 year of treatment.
A total of 91 PBC patients failed to respond adequately to UDCA, defined as patients whose liver biopsies showed persistent interface hepatitis and whose serum alkaline phosphatase levels remained more than 50% above normal after at least 12 months on UDCA. We added colchicine (0.6 mg orally twice daily) for 6 months. If there was no decrease in alkaline phosphatase, methotrexate (0.25 mg/kg lean body weight orally per week) was added. Liver biopsies were performed at least three times: at diagnosis, after a patient had been on UDCA for at least 1 year (mean 3.4 years), and after a patient had been on methotrexate for at least 6 months (mean 2.2 years). A fourth liver biopsy was performed in 51 patients after they had been on methotrexate for at least another year (mean 3.5 years).
From the time that methotrexate was begun until the final visit, there were significant decreases in the mean levels of alkaline phosphatase, 323 to 151, ALT, 73 to 39, fibrosis, 2.5 to 2.0, and inflammation scores, 2.0 to 1.0, (p < 0.0001 for all). Based on pre-specified definitions, 73 patients (80%) responded to methotrexate while 18 (20%) did not.
In 91 PBC patients who responded incompletely to UDCA, colchicine and methotrexate significantly improved liver enzyme tests and liver histology.
KeywordsPrimary biliary cirrhosis Unresponsive to ursodiol Response to methotrexate Colchicine
Conflict of interest statement
- 4.Corpechot C, Abenavoli L, Rabahi N, Chrétien Y, Andréani T, Johanet C, Chazouillères O, et al. Biochemical response to ursodeoxycholic acid and long-term prognosis in primary biliary cirrhosis. Hepatology. 2008;48:871–877.Google Scholar
- 5.Lee J, Belanger A, Friedman S, Bach N. Transplantation trends among primary biliary cirrhosis patients from 1995 to 2004. Hepatology. 2006;44:628A.Google Scholar
- 13.Gong Y, Gluud C. Methotrexate for primary biliary cirrhosis. Cochrane Database Syst Rev. 2005;Jul 20;(3):CD004385, PMID: 16034929.Google Scholar
- 19.Kaplan M, Schmid C, McKusick A, Provenzale D, Sharma A, Sepe T. Double-blind trial of methotrexate (MTX) versus colchicine (COLCH) in primary biliary cirrhosis. Hepatology. 1993;18:176A.Google Scholar
- 30.Menter A, Korman N, Elmets C, Feldman S, Gelfand JM, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 4. Guidelines of care for the management and treatment of psoriasis with traditional systemic agents. J Am Acad Dermatol. 2009;61:451–485.CrossRefPubMedGoogle Scholar