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Digestive Diseases and Sciences

, Volume 63, Issue 2, pp 529–532 | Cite as

Occurrence of Jaundice Following Simultaneous Ursodeoxycholic Acid Cessation and Obeticholic Acid Initiation

  • Gerard Quigley
  • Mustafa Al Ani
  • Abdul Nadir
Case Report

Introduction

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 [1]. 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.

Case Report

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...

Keywords

Ursodeoxycholic acid Obeticholic acid Primary biliary cholangitis Jaundice 

Notes

Author’s contribution

All authors have worked together in collecting data, reviewing medical literature, and writing up of this manuscript.

Compliance with ethical standards

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

Informed consent was obtained from the patient.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Maricopa Medical CenterPhoenixUSA

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