{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T18:51:32Z","timestamp":1770835892515,"version":"3.50.1"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":6087,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[1999,1]]},"abstract":"<jats:sec>\n            <jats:title\/>\n            <jats:p>We determined whether the normalization of serum bilirubin level (SBL) induced by ursodeoxycholic acid (UDCA) therapy was associated with an improved clinical outcome in patients with primary biliary cirrhosis (PBC). We estimated the prognostic values of SBL measured after 6 months of UDCA treatment for survival free of orthotopic liver transplantation (OLT). We used a database of 548 patients with PBC followed in three trials of UDCA. Among UDCA\u2013treated patients, we compared survival free of OLT in patients with normalized SBL (\u226417 \u03bcmol\/L) with those who had persistently elevated SBL. Difference in survival was tested between UDCA\u2013treated patients whose SBL normalized with treatment and placebo patients who had normal baseline SBL. We evaluated, in each treatment group, the prognostic value of 6\u2013month SBL. Survival was estimated using the Kaplan\u2013Meier method and compared by the Cox model. Survival free of OLT was significantly longer in patients who had normalized SBL (<jats:italic toggle=\"yes\">P &lt;<\/jats:italic> .0001; relative risk [RR]: 3.7, UDCA group). Survival free of OLT was not significantly different between UDCA patients with normalized SBL and placebo patients with a normal baseline SBL (<jats:italic toggle=\"yes\">P =<\/jats:italic> .69). For several cutoffs of 6\u2013month SBL, RRs of OLT or death were similar in UDCA\u2013treated and placebo patients: the RR of OLT or death associated with a 6\u2013month SBL more than 30 \u03bcmol\/L was 6.0 for UDCA and 5.7 for placebo groups. In conclusion, normalization of SBL during therapy is associated with improved clinical outcome. SBL under UDCA therapy is a prognostic factor in PBC. SBL under UDCA therapy should be interpreted as in untreated patients.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/hep.510290140","type":"journal-article","created":{"date-parts":[[2004,7,27]],"date-time":"2004-07-27T23:36:12Z","timestamp":1090971372000},"page":"39-43","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":70,"title":["Clinical Significance of Serum Bilirubin Levels Under Ursodeoxycholic Acid Therapy in Patients With Primary Biliary Cirrhosis"],"prefix":"10.1097","volume":"29","author":[{"given":"Anne-Marie","family":"Bonnand","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jenny E.","family":"Heathcote","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keith D.","family":"Lindor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ren\u00e9e Eug\u00e9nie","family":"Poupon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"10.1002\/hep.510290140-BIB1","doi-asserted-by":"crossref","first-page":"1548","DOI":"10.1056\/NEJM199105303242204","volume":"324","author":"Poupon","year":"1991","journal-title":"N Engl J Med"},{"key":"10.1002\/hep.510290140-BIB2","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1016\/0016-5085(94)90021-3","volume":"106","author":"Lindor","year":"1994","journal-title":"Gastroenterology"},{"key":"10.1002\/hep.510290140-BIB3","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1002\/hep.1840190512","volume":"19","author":"Heathcote","year":"1994","journal-title":"Hepatology"},{"key":"10.1002\/hep.510290140-BIB4","first-page":"759","volume":"22","author":"Combes","year":"1995","journal-title":"Hepatology"},{"key":"10.1002\/hep.510290140-BIB5","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1016\/S0016-5085(97)70183-5","volume":"113","author":"Poupon","year":"1997","journal-title":"Gastroenterology"},{"key":"10.1002\/hep.510290140-BIB6","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1136\/gut.20.2.137","volume":"20","author":"Shapiro","year":"1979","journal-title":"Gut"},{"key":"10.1002\/hep.510290140-BIB7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1056\/NEJM198301063080101","volume":"308","author":"Roll","year":"1983","journal-title":"N Engl J Med"},{"key":"10.1002\/hep.510290140-BIB8","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1016\/0016-5085(85)90213-6","volume":"89","author":"Christensen","year":"1985","journal-title":"Gastroenterology"},{"key":"10.1002\/hep.510290140-BIB9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/hep.1840100102","volume":"10","author":"Dickson","year":"1989","journal-title":"Hepatology"},{"key":"10.1002\/hep.510290140-BIB10","doi-asserted-by":"crossref","first-page":"63s","DOI":"10.1002\/hep.1840200714","volume":"20","year":"1994","journal-title":"Hepatology"},{"key":"10.1002\/hep.510290140-BIB11","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1080\/01621459.1958.10501452","volume":"53","author":"Kaplan","year":"1958","journal-title":"J Am Stat Assoc"},{"key":"10.1002\/hep.510290140-BIB12","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1002\/sim.4780080407","volume":"8","author":"Prentice","year":"1989","journal-title":"Stat Med"},{"key":"10.1002\/hep.510290140-BIB13","first-page":"301","volume-title":"Bile Acids as Therapeutic Agents. 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