{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T20:23:59Z","timestamp":1792700639811,"version":"4.5.0"},"reference-count":55,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2019,7,2]],"date-time":"2019-07-02T00:00:00Z","timestamp":1562025600000},"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":["Liver International"],"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background &amp; Aims<\/jats:title><jats:p>There is no proven treatment for ursodeoxycholic acid (UDCA)\u2010refractory primary biliary cholangitis (PBC) other than obeticholic acid. Although fibrates have been reported to improve biochemical parameters, the long\u2010term effects remain unclear. This study evaluated the effect of fibrate on clinical outcomes of UDCA\u2010refractory PBC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients whose alkaline phosphatase (ALP) was not normalized with at least 13\u00a0mg\/kg of UDCA treatment for &gt;1\u00a0year were included from two tertiary referral centres. The primary outcome was ALP normalization. Secondary outcomes included the development of cirrhosis and hepatic deterioration. Immortal time bias was adjusted using the Mantel\u2010Byar method.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 100 UDCA\u2010refractory PBC patients were included: 71 patients received UDCA alone (the UDCA group) and 29 patients received UDCA plus additional fibrate treatment of 160\u00a0mg\/d fenofibrate or 400\u00a0mg\/d bezafibrate (the fibrate\/UDCA group). During the follow\u2010up period, the probability of ALP normalization was significantly higher in the fibrate\/UDCA group (hazard ratio [HR]\u00a0=\u00a05.00, 95% confidence interval\u00a0=\u00a02.87\u20108.27, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). Among 58 non\u2010cirrhotic patients (43 in the UDCA group and 15 in the fibrate\/UDCA group), 19 patients (44.1%) in the UDCA group and none in the fibrate\/UDCA group developed cirrhosis (HR\u00a0=\u00a00.12, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.04). Hepatic deterioration (Child\u2010Pugh score increase or signs of decompensated cirrhosis) occurred in 17 patients (23.9%) of the UDCA group and none in the fibrate\/UDCA group in which the difference was significant (HR\u00a0=\u00a00.12, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.04).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In patients with UDCA\u2010refractory PBC, additional fibrate treatment is associated with a higher probability of ALP normalization and a lower risk of cirrhosis development and hepatic deterioration.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.14165","type":"journal-article","created":{"date-parts":[[2019,6,4]],"date-time":"2019-06-04T17:16:56Z","timestamp":1559668616000},"page":"1776-1785","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Additional fibrate treatment in UDCA\u2010refractory PBC 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National University College of Medicine Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun Sik","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Liver Research Institute Seoul National University College of Medicine Seoul Korea"},{"name":"Department of Internal Medicine Busan Paik Hospital, Inje University College of Medicine Busan Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6324-2224","authenticated-orcid":false,"given":"Jun Yong","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Yonsei University College of Medicine, Yonsei Liver Center, Severance Hospital Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3193-9745","authenticated-orcid":false,"given":"Yun Bin","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal 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