A Novel Treatment for Refractory Primary Biliary Cirrhosis?

Background/aims: Bezafibrate is naturally used for hyperlipidemia worldwide. In 1992 Day et al reported that the value of ALP and gamma-GTP in hyperlipidemia declined after administering bezafibrate orally. We conducted a study to investigate whether or not ALP and gamma-GTP in primary biliary cirrhosis which is characterized by the elevation of these enzymes improved after taking bezafibrate.

Methodology: We administered bezafibrate additionally for 6 months to 13 patients with primary biliary cirrhosis (refractory PBC) whose liver enzymes (ALP or gamma-GTP) did not remain within normal range out of 21 patients treated by monotherapy of ursodeoxycholic acid for 18 months.

Results: At 2, 4, and 6 months, gamma-GTP level significantly decreased compared with that prior to the initiation of bezafibrate. At 4 and 6 months, ALP level significantly decreased compared with that prior to the initiation. At 2, 4 and 6 months, ALT level significantly decreased compared with that prior to the initiation. The value of IgG and IgM was also reduced significantly 6 months after the initiation.

Conclusions: If the effectiveness of bezafibrate for primary biliary cirrhosis is confirmed histologically and by a randomized trial, a combination therapy of bezafibrate and ursodeoxycholic acid appear to be the medical treatment of choice for primary biliary cirrhosis in the future.