{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T15:43:28Z","timestamp":1779291808051,"version":"3.51.4"},"reference-count":29,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,6,21]],"date-time":"2023-06-21T00:00:00Z","timestamp":1687305600000},"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":["Hepatology Research"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aims<\/jats:title><jats:p>For patients with primary biliary cholangitis (PBC) exhibiting suboptimal responses to ursodeoxycholic acid (UDCA), obeticholic acid (OCA), and bezafibrate (BZF) are currently used and shown to improve long\u2010term outcomes. Nevertheless, we encounter patients who die or undergo liver transplantation (LT) even with combination treatment. In this study, we explored prognostic indicators in patients receiving combination treatment of UDCA and BZF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We took advantage of the Japanese PBC registry and enrolled patients who received both UDCA and BZF therapy in 2000 or later. The covariates investigated included baseline covariates as well as treatment covariates. Two main outcomes (all\u2010cause death or LT and liver\u2010related death or LT) were assessed using multivariable\u2010adjusted Cox proportional hazards models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 772 patients were included. The median follow\u2010up was 7.1\u00a0years. Using the Cox regression model, bilirubin (hazard ratio [HR] 6.85, 95% confidence interval [CI] 1.73\u201327.1, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.006), alkaline phosphatase (HR 5.46, 95% CI 1.32\u201322.6, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.019), and histological stage (HR 4.87, 95% CI 1.16\u201320.5, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.031) were found associated with LT\u2010free survival. For survival free from liver disease\u2010related death or LT, albumin (HR 7.72, 95% CI 1.48\u201340.4, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.016) and bilirubin (HR 14.5, 95% CI 2.37\u201388.5, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.004) were found significantly associated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In patients with PBC receiving combination therapy, prognostic variables were similar to those in patients receiving UDCA monotherapy. These results indicate the importance of diagnosing patients with PBC at an earlier stage because of the reduced effectiveness of BZF at advanced stages.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hepr.13931","type":"journal-article","created":{"date-parts":[[2023,6,9]],"date-time":"2023-06-09T02:50:02Z","timestamp":1686279002000},"page":"989-997","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Determinants of the effectiveness of bezafibrate combined with ursodeoxycholic acid in patients with primary biliary cholangitis"],"prefix":"10.1111","volume":"53","author":[{"given":"Kosuke","family":"Matsumoto","sequence":"first","affiliation":[{"name":"Department of Medicine Teikyo University School of Medicine  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junko","family":"Hirohara","sequence":"additional","affiliation":[{"name":"The Third Department of Internal Medicine Kansai Medical 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