A novel treatment for refractory primary biliary cirrhosis

Background/Aims: Bezafibrate is naturally used for hyperlipidemia worldwide. In 1992 Day et al report that the value of ALP and γ-GTP in hyperlipidemia declined after administering bezafibrate orally. We conducted a study to investigate whether or not ALP and γ-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 γ-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, γ-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, ' 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.