{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:47:33Z","timestamp":1789001253992,"version":"build-2803163510"},"reference-count":53,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2021,9,29]],"date-time":"2021-09-29T00:00:00Z","timestamp":1632873600000},"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":[[2021,11]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Ursodeoxycholic acid (UDCA) is the first\u2010line therapy for primary biliary cholangitis (PBC). However, nearly 40% of patients have an incomplete response to UDCA. The addition of bezafibrate has shown biochemical benefit in this group of patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To evaluate the long\u2010term effects of UDCA in combination with bezafibrate on histological outcomes in patients with UDCA\u2010refractory PBC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Fifty\u2010nine patients refractory to UDCA were included. Clinical parameters were monitored and paired liver biopsy (PLB) was performed after 5\u00a0years of follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the total cohort, 49 subjects were analysed and 31\u00a0had PLB at 5\u00a0years. Values for serum ALP, AST, ALT and GGT significantly improved with UDCA\u2010bezafibrate. This beneficial effect was observed at 12\u00a0months where 86% achieved ALP at normal levels. Analyses of PLB showed a significant decrease in liver damage as reflected by Ludwig (baseline 2.29\u00a0\u00b1\u00a01.2, to 1.84\u00a0\u00b1\u00a01 at year 5, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.0242) and Ishak (baseline 6.19\u00a0\u00b1\u00a02.2 to 4.77\u00a0\u00b1\u00a02.2 at year 5, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.0008) scores. Overall, regression of fibrosis was attained in 48% of patients. Furthermore, we observed a significant reduction in the proportion with cirrhosis from 19% at baseline to 3% at 5\u00a0years (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). These beneficial effects were associated with better predictive risk scores using the GLOBE and UK\u2010PBC prognosis models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Adding bezafibrate to UDCA in patients with UDCA\u2010refractory PBC showed a significant decrease in fibrosis and inflammatory histological scores at 5\u00a0years. These beneficial effects warrant further evaluation in long\u2010term cohort studies and controlled trials.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.16618","type":"journal-article","created":{"date-parts":[[2021,9,30]],"date-time":"2021-09-30T03:35:58Z","timestamp":1632972958000},"page":"1202-1212","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Bezafibrate therapy in primary biliary cholangitis refractory to ursodeoxycholic acid: a longitudinal study of paired liver biopsies at 5\u00a0years of follow up"],"prefix":"10.1111","volume":"54","author":[{"given":"Juan Antonio","family":"Sorda","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology University Hospital \u201cJos\u00e9 de San Mart\u00edn\u201d Faculty of Medicine University of Buenos Aires Buenos Aires Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esteban","family":"Gonz\u00e1lez 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