{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T10:25:30Z","timestamp":1784543130416,"version":"3.55.0"},"reference-count":36,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2015,11,12]],"date-time":"2015-11-12T00:00:00Z","timestamp":1447286400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2016,1]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Fibrates appear to improve biochemistry in patients with primary biliary cholangitis (<jats:styled-content style=\"fixed-case\">PBC<\/jats:styled-content>), but it is unclear which factors predict response and whether treatment improves transplant\u2010free survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To evaluate biochemical profiles, liver\u2010related outcomes and adverse events following fenofibrate therapy in<jats:styled-content style=\"fixed-case\">PBC<\/jats:styled-content>patients with incomplete response to ursodeoxycholic acid (<jats:styled-content style=\"fixed-case\">UDCA<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective cohort study was performed at a tertiary centre. Cox regression was used to compare outcomes between patients treated with fibrates and<jats:styled-content style=\"fixed-case\">UDCA<\/jats:styled-content>(<jats:styled-content style=\"fixed-case\">FF<\/jats:styled-content>) or<jats:styled-content style=\"fixed-case\">UDCA<\/jats:styled-content>alone, adjusted for a propensity score to account for treatment selection bias.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 120 patients were included (<jats:styled-content style=\"fixed-case\">FF<\/jats:styled-content>group<jats:italic>n<\/jats:italic>= 46,<jats:styled-content style=\"fixed-case\">UDCA<\/jats:styled-content>group<jats:italic>n<\/jats:italic>= 74, median fenofibrate treatment 11 months); 41% vs. 7% met the Toronto criteria for biochemical response [alkaline phosphatase \u22641.67 times the upper limit of normal] in the<jats:styled-content style=\"fixed-case\">FF<\/jats:styled-content>and<jats:styled-content style=\"fixed-case\">UDCA<\/jats:styled-content>groups, respectively (<jats:italic>P<\/jats:italic>= 0.0001). Fenofibrate was also associated with improved decompensation\u2010free and transplant\u2010free survival [hazard ratio (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>) 0.09, 95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>0.03\u20130.32,<jats:italic>P<\/jats:italic>= 0.0002]. However, only fenofibrate use, not biochemical response, was independently associated with improved outcomes on multivariable analysis (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>0.40, 95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>0.17\u20130.93,<jats:italic>P<\/jats:italic>= 0.03). Twenty\u2010two percent discontinued fenofibrate due to adverse events (most common: abdominal pain and myalgias). In cirrhotic patients, bilirubin increased more rapidly in the<jats:styled-content style=\"fixed-case\">FF<\/jats:styled-content>group (<jats:italic>P<\/jats:italic>= 0.005).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Fenofibrate therapy is associated with significant improvement in<jats:styled-content style=\"fixed-case\">alkaline phosphatase<\/jats:styled-content>, decompensation\u2010free and transplant\u2010free survival in<jats:styled-content style=\"fixed-case\">PBC<\/jats:styled-content>patients with incomplete<jats:styled-content style=\"fixed-case\">UDCA<\/jats:styled-content>response. However, fenofibrate should be used cautiously in cirrhosis, with close monitoring for clinical\/biochemical decompensation. Additional studies are required to assess the validity of<jats:styled-content style=\"fixed-case\">alkaline phosphatase<\/jats:styled-content>as an appropriate response criteria for fibrate therapy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.13465","type":"journal-article","created":{"date-parts":[[2015,11,12]],"date-time":"2015-11-12T07:42:43Z","timestamp":1447314163000},"page":"283-293","source":"Crossref","is-referenced-by-count":131,"title":["Combined ursodeoxycholic acid (<scp>UDCA<\/scp>) and fenofibrate in primary biliary cholangitis patients with incomplete<scp>UDCA<\/scp>response may improve outcomes"],"prefix":"10.1111","volume":"43","author":[{"given":"A. C.","family":"Cheung","sequence":"first","affiliation":[{"name":"Toronto Centre for Liver Disease Toronto Western and General Hospital University Health Network University of Toronto Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Lapointe\u2010Shaw","sequence":"additional","affiliation":[{"name":"Mount Sinai Hospital and Department of Medicine University of Toronto Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Kowgier","sequence":"additional","affiliation":[{"name":"Toronto Centre for Liver Disease Toronto Western and General Hospital University Health Network University of Toronto Toronto Canada"},{"name":"Dalla Lana School of Public Health University of Toronto Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Meza\u2010Cardona","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Hospital Espa\u00f1ol Mexico D.F Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. M.","family":"Hirschfield","sequence":"additional","affiliation":[{"name":"Centre for Liver Research National Institute for Health Research Biomedical Research Unit University of Birmingham Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. L. A.","family":"Janssen","sequence":"additional","affiliation":[{"name":"Toronto Centre for Liver Disease Toronto Western and General Hospital University Health Network University of Toronto Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. J.","family":"Feld","sequence":"additional","affiliation":[{"name":"Toronto Centre for Liver Disease Toronto Western and General Hospital University Health Network University of Toronto Toronto Canada"},{"name":"McLaughlin\u2010Rotman Centre for Global Health University of Toronto Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,11,12]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/764684"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-pathol-020712-164014"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.12581"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.510290603"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(94)90021-3"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2005.12.029"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2004.11.009"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2010.216"},{"key":"e_1_2_7_10_1","first-page":"669","article-title":"Effect of clofibrate on plasma levels of alkaline phosphatase","volume":"297","author":"Zumoff B","year":"1977","journal-title":"N Engl J Med"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2009.04104.x"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1042\/bj3140781"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10354-008-0592-1"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1023\/B:PHAM.0000041444.06122.8d"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1021\/jm990554g"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOG.0000000000000056"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.22906"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.510290140"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.crad.2009.05.010"},{"key":"e_1_2_7_20_1","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1093\/oso\/9780198524847.001.0001","volume-title":"Analysis of Longitudinal Data","author":"Diggle P","year":"2002"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2000.01667.x"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2000.03220.x"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hepres.2004.04.001"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2015.20"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1872-034X.2007.00305.x"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2009.01.003"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.26322"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840100102"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.26155"},{"key":"e_1_2_7_30_1","volume-title":"Product Monograph: Lipidil EZ","author":"BGP Pharma ULC","year":"2015"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2010.04512.x"},{"key":"e_1_2_7_32_1","first-page":"245","article-title":"Fenofibrate\u2010induced acute cholestatic hepatitis","volume":"67","author":"Ho CY","year":"2004","journal-title":"J Chin Med Assoc"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.2515\/therapie\/2010011"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.12290"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(97)70183-5"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2014.08.029"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcu.1870210502"}],"container-title":["Alimentary Pharmacology &amp; 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