High biochemical remission rates in patients with primary biliary cholangitis treated with “triple” anticholestatic therapy
Bibliographic record
Abstract
BACKGROUND: Treatment goals in primary biliary cholangitis (PBC) are increasingly aspirational, aiming for normal serum liver tests. One of the add-on therapies to ursodeoxycholic acid (UDCA) is with the approved farnesoid X receptor (FXR) agonist obeticholic acid (OCA), alongside off-label use of fibrates (peroxisome proliferator-activated receptor [PPARs]). We report our experience of synergistic FXR-PPAR-UDCA combination therapy in PBC. METHODS: A review of patients with PBC seen between July 2022 and July 2023 was performed across the autoimmune liver disease programme at the Toronto Centre for Liver Disease. Univariate and multivariate analyses were performed. RESULTS: Four hundred seventy patients with PBC were seen, of which 71% were treated with UDCA only, 7% UDCA-OCA, 11.3% UDCA-fibrates, and 10.6% UDCA-OCA-fibrates. Among 50 patients on triple therapy, 82% had OCA as the first add-on therapy. Most patients (92%) received bezafibrate, while 8% had fenofibrate. Forty-eight patients were included in the final analysis. The mean follow-up time after triple therapy was 17.4 months. Triple therapy demonstrated median ALP reductions after 6 months of 33.3% (95% CI: 27.9%-37.6%) and 39.1% (95% CI: 30.7%-46.2%) at the last follow up; 30.2% of the patients had a normal serum ALP at 6 months, while 11.9% had normal ALP, AST, ALT, and bilirubin. Subgroup analysis of 28 patients followed for at least 12 months showed a 44.7% (95% CI: 33.3%-50.9%) median reduction in ALP. Liver stiffness remained relatively stable throughout the follow-up. Out of 34 patients with self-reported pruritus before triple therapy, 64.7% reported improvement, 11.8% worsened, and 23.5% had no change in itching intensity. On multivariable analysis, only older age at diagnosis (OR=1.12; 95% CI: 1.02-1.22) positively impacted ALP normalization. CONCLUSIONS: Our data confirm that FXR-PPAR-UDCA triple therapy significantly improves ALP with normalization for 30% of patients with PBC at 6 months.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".