{"id":2329,"date":"2020-09-25T22:13:28","date_gmt":"2020-09-25T20:13:28","guid":{"rendered":"https:\/\/angh.net\/abstracts\/effet-benefique-de-la-combinaison-fibrates-acide-obeticholique-et-acide-ursodesoxycholique-dans-le-traitement-de-la-cholangite-biliaire-primitive-avec-reponse-incomplete-aux-therapies-de-2eme-ligne\/"},"modified":"2020-09-25T22:13:28","modified_gmt":"2020-09-25T20:13:28","slug":"effet-benefique-de-la-combinaison-fibrates-acide-obeticholique-et-acide-ursodesoxycholique-dans-le-traitement-de-la-cholangite-biliaire-primitive-avec-reponse-incomplete-aux-therapies-de-2eme-ligne","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/effet-benefique-de-la-combinaison-fibrates-acide-obeticholique-et-acide-ursodesoxycholique-dans-le-traitement-de-la-cholangite-biliaire-primitive-avec-reponse-incomplete-aux-therapies-de-2eme-ligne\/","title":{"rendered":"EFFET B\u00c9N\u00c9FIQUE DE LA COMBINAISON FIBRATES, ACIDE OB\u00c9TICHOLIQUE ET ACIDE URSOD\u00c9SOXYCHOLIQUE DANS LE TRAITEMENT DE LA CHOLANGITE BILIAIRE PRIMITIVE AVEC R\u00c9PONSE INCOMPL\u00c8TE AUX TH\u00c9RAPIES DE 2\u00e8me LIGNE"},"content":{"rendered":"

2020<\/strong><\/p>\n

Pierre-Antoine Soret1, Laurent Lam1, Fabrice Carrat1, Lena Smets2, Vincent Leroy3, Thomas Berg4, Marco Carbone5, Pietro Invernizzi5, Palak Trivedi6, Christina Weiler-Normann7, Laurent Alric8, Isabelle Rosa-Hezode3, Jean-Paul Cervoni9, J\u00e9r\u00f4me Dumortier10, Pascal Potier11, Olivier Roux12, Christine Silvain13, Cynthia Levy14, Albert Pares15, Christoph Schramm16, Fran\u00e7ois Boer1, Frederik Nevens2, Olivier Chazouill\u00e8res1, Christophe Corpechot1<\/em><\/p>\n

H\u00e9patologie <\/strong>– \u00a02020-07-06 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

L\u2019acide ob\u00e9ticholique (AOC) et le b\u00e9zafibrate sont les deux seuls m\u00e9dicaments \u00e0 avoir montr\u00e9 un effet b\u00e9n\u00e9fique significatif sur les param\u00e8tres biologiques des patients atteints de cholangite biliaire primitive (CBP) avec r\u00e9ponse incompl\u00e8te \u00e0 l\u2019acide ursod\u00e9soxycholique (AUDC). En revanche, on ne sait pas si l\u2019association d\u2019AOC et de fibrates en ajout \u00e0 l\u2019AUDC peut avoir des effets b\u00e9n\u00e9fiques compl\u00e9mentaires chez des patients en r\u00e9ponse incompl\u00e8te aux traitements de 2\u00e8me ligne.
\nM\u00e9thodes :
\nCette \u00e9tude de cohorte r\u00e9trospective multicentrique a inclus des patients atteints de CBP ayant tous \u00e9t\u00e9 trait\u00e9s pendant au moins 12 semaines et sans intol\u00e9rance \u00e9vidente par une combinaison d\u2019AOC (5-10 mg\/j), de fibrates (b\u00e9zafibrate 400 mg\/j ou f\u00e9nofibrate 200 mg\/j) et d\u2019AUDC (13-15 mg\/kg\/j) en raison d\u2019une r\u00e9ponse incompl\u00e8te selon les crit\u00e8res de Paris-2 \u00e0 l\u2019un des traitements de 2\u00e8me ligne. La date de r\u00e9f\u00e9rence \u00e9tait la date d\u2019introduction du traitement de 2\u00e8me ligne. Les tests biologiques h\u00e9patiques mesur\u00e9s sous bi- puis tri-th\u00e9rapie ont \u00e9t\u00e9 recueillis. Le crit\u00e8re de jugement principal \u00e9tait le taux de variation des phosphatases alcalines (PAL) par unit\u00e9 de temps. Les crit\u00e8res de jugement secondaires \u00e9taient le taux de normalisation des PAL et les taux de variation par unit\u00e9 de temps de la bilirubine totale, de la GGT, des ASAT et ALAT et du score de prurit. Ces crit\u00e8res ont \u00e9t\u00e9 \u00e9valu\u00e9s \u00e0 l\u2019aide de mod\u00e8les lin\u00e9aires \u00e0 effets mixtes ajust\u00e9s sur l\u2019\u00e2ge, le sexe et la posologie des m\u00e9dicaments.
\nR\u00e9sultats :
\n50 patients provenant de 16 centres et de 7 pays (France, Belgique, Allemagne, Italie, Royaume Uni, Espagne, USA) ont \u00e9t\u00e9 inclus : \u00e2ge moyen (d\u00e9viation standard) \u00e0 la date de r\u00e9f\u00e9rence 49,7 (11,1) ans; sexe f\u00e9minin 88%; dose d\u2019AUDC 15,2 (2,9) mg\/kg\/j; PAL 370 (240) UI\/L; bilirubine total 14,8 (8,7) \u00b5mole\/L; \u00e9lastom\u00e9trie 13,0 (9,8) kPa. Parmi eux, 24 (Groupe 1) avaient re\u00e7u l\u2019AOC en 2\u00e8me ligne et les fibrates en 3\u00e8me ligne, tandis que 26 (Groupe 2) avaient re\u00e7u les fibrates en 2\u00e8me ligne et l\u2019AOC en 3\u00e8me ligne, toujours en association \u00e0 l\u2019AUDC. Les dur\u00e9es moyennes de suivi sous bith\u00e9rapie et sous trith\u00e9rapie \u00e9taient respectivement de 39,7 (29,3) mois et 9,4 (6,6) mois. La trith\u00e9rapie \u00e9tait associ\u00e9e \u00e0 un taux de diminution des PAL significatif par rapport \u00e0 la bith\u00e9rapie: -27%\/an (IC95%: -15%\/an \u2013 -36%\/an; p<0,0001) et cet effet \u00e9tait significatif dans les 2 groupes (Figure). Compar\u00e9e \u00e0 la bith\u00e9rapie, la trith\u00e9rapie \u00e9tait associ\u00e9e \u00e0 un rapport de chances pour la normalisation des PAL de 5,5 (IC95%: 1,8 \u2013 17,1; p=0,003) ainsi qu\u2019\u00e0 une diminution significative de la GGT (p<0,0001), des ALAT (p<0,001), des ASAT (p<0,01) et de la bilirubine totale (p=0,02). La trith\u00e9rapie \u00e9tait associ\u00e9e \u00e0 une diminution du score de prurit dans le Groupe 1 (p=0,02) mais pas dans le groupe 2. A la derni\u00e8re visite, aucun patient n\u2019avait arr\u00eat\u00e9 la trith\u00e9rapie. \nConclusion : \nLa trith\u00e9rapie associant fibrates, AOC et AUDC am\u00e9liore les tests h\u00e9patiques et augmente les chances de normalisation des PAL chez les patients atteints de CBP ayant une r\u00e9ponse incompl\u00e8te \u00e0 un traitement de 2\u00e8me ligne.\n<\/p>\n","protected":false},"excerpt":{"rendered":"

2020 Pierre-Antoine Soret1, Laurent Lam1, Fabrice Carrat1, Lena Smets2, Vincent Leroy3, Thomas Berg4, Marco Carbone5, Pietro Invernizzi5, Palak Trivedi6, Christina Weiler-Normann7, Laurent Alric8, Isabelle Rosa-Hezode3, Jean-Paul Cervoni9, J\u00e9r\u00f4me Dumortier10, Pascal Potier11, Olivier Roux12, Christine Silvain13, Cynthia Levy14, Albert Pares15, Christoph Schramm16, Fran\u00e7ois Boer1, Frederik Nevens2, Olivier Chazouill\u00e8res1, Christophe Corpechot1 H\u00e9patologie – \u00a02020-07-06 –\u00a0CO – ________________________________ […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[3],"tags":[31],"class_list":["post-2329","post","type-post","status-publish","format-standard","hentry","category-hepatologie","tag-31"],"yoast_head":"\nEFFET B\u00c9N\u00c9FIQUE DE LA COMBINAISON FIBRATES, ACIDE OB\u00c9TICHOLIQUE ET ACIDE URSOD\u00c9SOXYCHOLIQUE DANS LE TRAITEMENT DE LA CHOLANGITE BILIAIRE PRIMITIVE AVEC R\u00c9PONSE INCOMPL\u00c8TE AUX TH\u00c9RAPIES DE 2\u00e8me LIGNE - 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