{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T08:57:09Z","timestamp":1784883429142,"version":"3.55.0"},"reference-count":49,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2024,5,1]],"date-time":"2024-05-01T00:00:00Z","timestamp":1714521600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Suboptimal response to ursodeoxycholic acid occurs in 40% of primary biliary cholangitis (PBC) patients, affecting survival. Achieving a deep response (normalisation of alkaline phosphatase [ALP] and bilirubin \u22640.6 upper limit of normal) improves survival. Yet, the long\u2010term effectiveness of second\u2010line treatments remains uncertain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To evaluate the long\u2010term effectiveness of obeticholic acid (OCA)\u2009\u00b1\u2009fibrates. Focusing on biochemical response (ALP \u22641.67 times the upper limit of normal, with a decrease of at least 15% from baseline and normal bilirubin levels), normalisation of ALP, deep response and biochemical remission (deep response plus aminotransferase normalisation).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a longitudinal, observational, multicentre study involving ursodeoxyccholic acid non\u2010responsive PBC patients (Paris\u2010II criteria) from Spain and Portugal who received OCA\u2009\u00b1\u2009fibrates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 255 patients, median follow\u2010up was 35.1\u2009months (IQR: 20.2\u201353). The biochemical response in the whole cohort was 47.2%, 61.4% and 68.6% at 12, 24 and 36\u2009months. GLOBE\u2010PBC and 5\u2010year UK\u2010PBC scores improved (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Triple therapy (ursodeoxycholic acid plus OCA plus fibrates) had significantly higher response rates than dual therapy (<jats:italic>p<\/jats:italic>\u2009=\u20090.001), including ALP normalisation, deep response and biochemical remission (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). In multivariate analysis, triple therapy remained independently associated with biochemical response (<jats:italic>p<\/jats:italic>\u2009=\u20090.024), alkaline phosphatase normalisation, deep response and biochemical remission (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Adverse effects occurred in 41.2% of cases, leading to 18.8% discontinuing OCA. Out of 55 patients with cirrhosis, 12 developed decompensation. All with baseline portal hypertension.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Triple therapy was superior in achieving therapeutic goals in UDCA\u2010nonresponsive PBC. Decompensation was linked to pre\u2010existing portal hypertension.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.18004","type":"journal-article","created":{"date-parts":[[2024,5,1]],"date-time":"2024-05-01T09:58:25Z","timestamp":1714557505000},"page":"1604-1615","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Longitudinal outcomes of obeticholic acid therapy in ursodiol\u2010nonresponsive primary biliary cholangitis: Stratifying the impact of add\u2010on fibrates in real\u2010world practice"],"prefix":"10.1111","volume":"59","author":[{"given":"E.","family":"G\u00f3mez","sequence":"first","affiliation":[{"name":"Hospital Universitario 12 De Octubre  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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