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• W4386886257 abstract "<h3>Background</h3> Liver stiffness measurements (LSM) have been determined to be one of the best markers for detection of advanced fibrosis or cirrhosis in primary biliary cholangitis (PBC).¹ LSM of 9.6kPa or greater is associated with a 5-fold increase in the risk of liver decompensation, liver transplantation, and death.¹ The 5 year open-label extension of the POISE trial demonstrated that non-invasive markers of liver fibrosis stabilised with obeticholic acid (OCA) treatment.² This is important as worsening LSM is associated with a poor prognosis.¹ <h3>Method</h3> Between November 2017 and December 2021, 169 patients were referred to the King’s PBC MDM for consideration of second line therapies. 87 patients were recommended to start OCA. Baseline and follow up Fibroscan data after 1 year of OCA treatment was collected for each patient and assessed alongside ALP levels. <h3>Results</h3> 69 (79%) patients had baseline Fibroscan results available. 40 patients were still on OCA and under the King’s PBC MDM at month 12. Of these, 25 patients had follow up Fibroscans available. 7/25 (28%) patients demonstrated a stable LSM whereby the change in LSM was less than 20% from baseline (p=0.7344). 11/25 (44%) patients saw an improvement in LSM (20% or greater decrease in LSM from baseline) after at least 12 months of OCA which was statistically significant (p = 0.001). 10 of these patients had achieved the maximum dose of OCA 10mg once daily. 1 of these patients demonstrated an improvement in LSM despite an increase in ALP at 1 year. 7/25 (28%) patients saw a worsening of LSM (20% or greater increase in LSM from baseline). (p=0.0156) Despite seeing a biochemical response (ALP <1.67xULN), 2 patients demonstrated a worsening LSM. Median LSM at follow up was 8kPa (range: 2.8–28.3kPa). <h3>Discussion</h3> Local data showed that 72% of patients demonstrated a stable or improved LSM after 1 year or more of OCA therapy. 37.5% of patients prescribed OCA did not have follow-up LSM data available. Currently, national and international guidelines make no recommendation on how often transient elastography should be performed in PBC. Follow up Fibroscans were completed more frequently for patients monitored at KCH than patients under local follow up at referring sites. This could be due to the availability of transient elastography at referring sites. ELF scores could be used to monitor fibrosis, as demonstrated in the POISE trial.² This project highlights the need for standardised fibrosis monitoring across our network. <h3>References</h3> Hirschfield GM, Beuers U, Corpechot C, <i>et al.</i> EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis. <i>Journal of Hepatology</i> 2017;<b>67</b>:145–72. doi:10.1016/j.jhep.2017.03.022 Nevens, <i>et al.</i> 2019. Durable Response in the Markers of Cholestasis Through 5 Years of Open-Label Extension Study of Obeticholic Acid in Primary Biliary Cholangitis. <i>Digestive and Liver Disease</i> 2020;<b>1</b>:e30. Doi: 10.1016/j.dld.2019.12.114" @default.
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• W4386886257 date "2023-09-01" @default.
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• W4386886257 title "P103 Does treatment with obeticholic acid result in improvement or stabilisation of non-invasive fibrosis scores in PBC?" @default.
• W4386886257 doi "https://doi.org/10.1136/gutjnl-2023-basl.118" @default.
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