Occurrence of Jaundice Following Simultaneous Ursodeoxycholic Acid Cessation and Obeticholic Acid Initiation
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Primary biliary cholangitis (PBC) is a chronic autoimmune cholestatic disease for which ursodeoxycholic acid (UDCA) has been the mainstay of treatment. Obeticholic acid (OCA) emerged in 2016 as a second agent for PBC treatment. It is indicated for use in combination with UDCA in patients who have had an inadequate response to UDCA, or as sole treatment in adults unable to tolerate UDCA. Intriguingly, OCA has been reported to induce dose-dependent jaundice, despite the fact that it reduces bile acid synthesis and improves bile flow . Herein we report a case of severe jaundice that occurred in a PBC patient 8 weeks after abrupt cessation of UDCA and simultaneous initiation of OCA therapy.
A 55-year-old Hispanic female was evaluated for an elevated alkaline phosphatase (ALP). She had no history of using alcohol, recreational drugs, or over-the-counter (OTC) medications. Laboratory studies in 2012 showed a platelet count of 200 k/µ/L, alanine aminotransferase...
KeywordsUrsodeoxycholic acid Obeticholic acid Primary biliary cholangitis Jaundice
All authors have worked together in collecting data, reviewing medical literature, and writing up of this manuscript.
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Conflict of interest
The authors Abdul Nadir M.D., Gerard Quigley N.P., and Mustafa Al Ani M.D. certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
Informed consent was obtained from the patient.
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