{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:47:03Z","timestamp":1789001223763,"version":"build-2803163510"},"reference-count":24,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T00:00:00Z","timestamp":1616630400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Obeticholic acid (OCA) and fibrates are second\u2010line therapies for patients with primary biliary cholangitis (PBC) with an inadequate response to ursodeoxycholic acid (UDCA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To know whether OCA and fibrates, administered together in combination with UDCA, have additive beneficial effects in patients with difficult\u2010to\u2010treat PBC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PBC patients treated for \u22653\u00a0months with UDCA, OCA and fibrates (bezafibrate or fenofibrate) due to failure of either second\u2010line therapy were included in a multicentre, uncontrolled retrospective cohort study. Changes in biochemical liver tests and pruritus were analysed using a generalised linear mixed\u2010effect model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 58 patients included, half received OCA as second\u2010line and fibrates as third\u2010line therapy (Group OCA\u2010Fibrate), while the other half had the inverse therapeutic sequence (Group Fibrate\u2010OCA). The mean duration of triple therapy was 11\u00a0months (range 3\u201026). Compared to dual therapy, triple therapy was associated with a significant gain in alkaline phosphatase (ALP) reduction: 22% per first year (95% CI 12%\u201031%), an effect that was stronger in OCA\u2010Fibrate than in Fibrate\u2010OCA group. Triple therapy was associated with a 3.4 (95% CI 1.4\u20108.2) odds ratio (OR) of reaching normal ALP and with a significant decrease in gamma\u2010glutamyl transpeptidase (GGT), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin. The ORs of achieving the Paris\u20102 and Toronto criteria of adequate biochemical response were 6.8 (95% CI 2.8\u201016.7) and 9.2 (95% CI 3.4\u201025.1) respectively. Finally, triple therapy significantly improved pruritus in OCA\u2010Fibrate but not in Fibrate\u2010OCA group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Triple therapy with UDCA, OCA and fibrates is able to normalise biochemical liver tests and improve pruritus in patients with difficult\u2010to\u2010treat PBC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/apt.16336","type":"journal-article","created":{"date-parts":[[2022,4,6]],"date-time":"2022-04-06T04:44:44Z","timestamp":1649220284000},"page":"1138-1146","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":76,"title":["Combination of fibrates with obeticholic acid is able to normalise biochemical liver tests in patients with difficult\u2010to\u2010treat primary biliary cholangitis"],"prefix":"10.1111","volume":"53","author":[{"given":"Pierre\u2010Antoine","family":"Soret","sequence":"first","affiliation":[{"name":"Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Lam","sequence":"additional","affiliation":[{"name":"Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrice","family":"Carrat","sequence":"additional","affiliation":[{"name":"Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena","family":"Smets","sequence":"additional","affiliation":[{"name":"Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Berg","sequence":"additional","affiliation":[{"name":"Leipzig Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1445-0443","authenticated-orcid":false,"given":"Marco","family":"Carbone","sequence":"additional","affiliation":[{"name":"Monza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3262-1998","authenticated-orcid":false,"given":"Pietro","family":"Invernizzi","sequence":"additional","affiliation":[{"name":"Monza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Leroy","sequence":"additional","affiliation":[{"name":"Grenoble France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Palak","family":"Trivedi","sequence":"additional","affiliation":[{"name":"Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora","family":"Cazzagon","sequence":"additional","affiliation":[{"name":"Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Weiler\u2010Normann","sequence":"additional","affiliation":[{"name":"Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Alric","sequence":"additional","affiliation":[{"name":"Toulouse France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Rosa\u2010Hezode","sequence":"additional","affiliation":[{"name":"Cr\u00e9teil France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Heurgu\u00e9","sequence":"additional","affiliation":[{"name":"Reims France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean\u2010Paul","family":"Cervoni","sequence":"additional","affiliation":[{"name":"Besan\u00e7on France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7824-5396","authenticated-orcid":false,"given":"J\u00e9r\u00f4me","family":"Dumortier","sequence":"additional","affiliation":[{"name":"Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Potier","sequence":"additional","affiliation":[{"name":"Orl\u00e9ans France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Roux","sequence":"additional","affiliation":[{"name":"Clichy France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Silvain","sequence":"additional","affiliation":[{"name":"Poitiers France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Bureau","sequence":"additional","affiliation":[{"name":"Toulouse France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodolphe","family":"Anty","sequence":"additional","affiliation":[{"name":"Nice France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique","family":"Larrey","sequence":"additional","affiliation":[{"name":"Montpellier France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Levy","sequence":"additional","affiliation":[{"name":"Miami USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Pares","sequence":"additional","affiliation":[{"name":"Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Schramm","sequence":"additional","affiliation":[{"name":"Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik","family":"Nevens","sequence":"additional","affiliation":[{"name":"Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Chazouill\u00e8res","sequence":"additional","affiliation":[{"name":"Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7920-9784","authenticated-orcid":false,"given":"Christophe","family":"Corpechot","sequence":"additional","affiliation":[{"name":"Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,3,25]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.16023"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2017.03.022"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.30145"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/hepr.12270"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2019.04.001"},{"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":"10.1002\/hep.22428"},{"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":"30926\u20105","article-title":"Definition and management of patients with primary biliary cholangitis and an incomplete response to therapy","volume":"3","author":"Montano\u2010Loza AJ","year":"2020","journal-title":"Clin Gastroenterol Hepatol"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1509840"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(19)30094-9"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31017"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1386-6346(99)00033-9"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1714519"},{"key":"e_1_2_7_16_1","article-title":"Fibrates for Itch (FITCH) in fibrosing cholangiopathies: a double\u2010blind, randomized, placebo\u2010controlled trial","volume":"5","author":"Vries E","year":"2020","journal-title":"Gastroenterology"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2010.04512.x"},{"key":"e_1_2_7_18_1","first-page":"10.1002\/hep.316","article-title":"Improved markers of cholestatic liver injury in patients with primary biliary cholangitis treated with obeticholic acid and bezafibrate","volume":"3","author":"Smets L","year":"2020","journal-title":"Hepatology"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2011.02.031"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.510280203"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2014.08.029"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000000557"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2017.287"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2012.12.005"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8278(99)80136-6"}],"container-title":["Alimentary Pharmacology &amp; Therapeutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.16336","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/apt.16336","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.16336","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T09:32:30Z","timestamp":1693560750000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/apt.16336"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,25]]},"references-count":24,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2021,5]]}},"alternative-id":["10.1111\/apt.16336"],"URL":"https:\/\/doi.org\/10.1111\/apt.16336","archive":["Portico"],"relation":{},"ISSN":["0269-2813","1365-2036"],"issn-type":[{"value":"0269-2813","type":"print"},{"value":"1365-2036","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,25]]},"assertion":[{"value":"2020-12-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-03-01","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-03-25","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}