sulindac and Liver-Cirrhosis--Biliary

The primary biliary cirrhosis (PBC) is a chronic, progressive disease of unknown origin with immune pathomechanism. The disease is accompanied with the chronic inflammation of the small and middle intra-hepatic bile ducts. It occurs in 90 per cent of women. The authors summarizes the possibilities ot its therapy after the review of the pathogenesis and clinical findings. They discuss the pathomechanism and the effects on the biochemical and histological findings of ursodeoxycholic acid (UDCA), which is the basis therapy of this disease, The place and indication of immunosuppressive drugs as well as possibilities of immune modulation are also reviewed on the basis of literary data. The therapy in the complication PBC and concomitant diseases are also discussed. The authors mention the opportunities of the therapy which will be applied in the future as a fruitful therapy.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Anti-Retroviral Agents; Bezafibrate; Eosinophilia; Humans; Hypolipidemic Agents; Immunologic Factors; Immunosuppressive Agents; Liver Cirrhosis, Biliary; Liver Transplantation; Sulindac; Ursodeoxycholic Acid

In 30% of patients with primary biliary cirrhosis (PBC) ursodeoxycholic acid (UDCA) causes full biochemical normalization, while 70% are incomplete responders. The only differences between the two groups are the significantly higher cholestasis indices in the incomplete responders. In these patients we investigated whether the strongly choleretic sulindac together with UDCA is superior to UDCA monotherapy.. Twenty-three patients with PBC incompletely responding to UDCA monotherapy were entered in the open label study for 12 months. Eleven patients (stage II, seven; III, two; and IV, two) received UDCA (10-15 mg/kg/day) plus sulindac (100-300 mg/day) (Group I). Twelve patients (stage I, six; II, four; III, one; and IV, one) were treated with UDCA alone (Group II). Liver biochemistry, analysis of antimitochondrial, antinuclear, smooth muscle, and liver-kidney-microsomal antibodies, ultrasonography and gastroscopy were done in regular intervals.. In Group I all liver indices, IgG, IgM and IgA significantly improved although pretreatment data and stages of the disease tended to be higher than in Group II. In five patients of Group I liver histology improved slightly. Sulindac was well tolerated. The biochemical indices did not further improve on UDCA monotherapy.. Sulindac in combination with UDCA further improves liver biochemistries in patients with PBC who responded incompletely to UDCA alone.

Topics: Aged; Anti-Inflammatory Agents, Non-Steroidal; Cholagogues and Choleretics; Drug Therapy, Combination; Female; Humans; Liver Cirrhosis, Biliary; Male; Middle Aged; Pilot Projects; Sulindac; Ursodeoxycholic Acid