--- title: "Ursodeoxycholic acid treatment for biliary cholangitis. | Sutter Health" description: "Among African Americans with primary biliary cholangitis, ursodeoxycholic acid treatment was associated with significantly lower mortality." url: "https://www.sutterhealth.org/research/publications/ursodeoxycholic-acid-treatment-for-biliary-cholangitis-1055312732" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Ursodeoxycholic acid treatment for biliary cholangitis. # Ursodeoxycholic acid treatment preferentially improves overall survival among African Americans with primary biliary cholangitis. Gordon SC, Wu KH, Lindor K, Bowlus CL, Rodriguez CV, Anderson H, Boscarino JA, Trudeau S, Rupp LB, Haller IV, Romanelli RJ, VanWormer JJ, Schmidt MA, Daida YG, Sahota A, Vincent J, Zhang T, Li J, & Lu M; FOLD Investigators. _Am J Gastroenterol. 2020 Jan 27. doi: 10.14309/ajg.0000000000000512. \[Epub ahead of print\]_ 2020-01-27 ## Abstract BACKGROUND: We used data from the Fibrotic Liver Disease Consortium to evaluate the impact of ursodeoxycholic acid (UDCA) treatment across race/ethnicity, gender, and clinical status among patients with primary biliary cholangitis. METHODS: Data were collected from "index date" (baseline) through December 31, 2016. Inverse Probability of Treatment Weighting was used to adjust for UDCA treatment selection bias. Cox regression, focusing on UDCA-by-risk factor interactions, was used to assess the association between treatment and mortality and liver transplant/death. RESULTS: Among 4,238 patients with primary biliary cholangitis (13% men; 8% African American, 7% Asian American/American Indian/Pacific Island \[ASINPI\]; 21% Hispanic), 78% had ever received UDCA. The final multivariable model for mortality retained age, household income, comorbidity score, total bilirubin, albumin, alkaline phosphatase, and interactions of UDCA with race, gender, and aspartate aminotransferase/alanine aminotransferase ≥1.1. Among untreated patients, African Americans and ASINPIs had higher mortality than whites (adjusted hazard ratio \[aHR\] = 1.34, 95% confidence interval \[CI\] 1.08-1.67 and aHR = 1.40, 95% CI 1.11-1.76, respectively). Among treated patients, this relationship was reversed (aHR = 0.67, 95% CI 0.51-0.86 and aHR = 0.88, 95% CI 0.67-1.16). Patterns were similar for liver transplant/death. UDCA reduced the risk of liver transplant/death in all patient groups and mortality across all groups except white women with aspartate aminotransferase/alanine aminotransferase ≥1.1. As compared to patients with low-normal bilirubin at baseline (≤0.4 mg/dL), those with high-normal (1.0 > 0.7) and mid-normal bilirubin (0.7 > 0.4) had significantly higher liver transplant/death and all-cause mortality. DISCUSSION: African American and ASINPI patients who did not receive UDCA had significantly higher mortality than white patients. Among African Americans, treatment was associated with significantly lower mortality. Regardless of UDCA treatment, higher baseline bilirubin, even within the normal range, was associated with increased mortality and liver transplant/death compared with low-normal levels. [PubMed abstract](https://www.ncbi.nlm.nih.gov/pubmed/31985529) ## Research topics - [Health Disparities](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Disparities%5C%22%22) - [Liver Diseases and Transplant](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Liver+Diseases+and+Transplant%5C%22%22) - [Medical Informatics](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Medical+Informatics%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Factors associated with prevalence and treatment of primary biliary cholangitis in United States health systems.](https://www.sutterhealth.org/research/publications/prevalence-tx-biliary-cholangitis-in-us-1055312312) Lu M, Li J, Haller IV, Romanelli RJ, VanWormer JJ, Rodriguez CV, Raebel MA, Boscarino JA, Schmidt MA, Daida YG, Sahota A, Vincent J, Bowlus CL, Lindor K, Rupp LB, Gordon SC; FOLD Investigators. Clin Gastroenterol Hepatol. pii: S1542-3565(17)31243-0. doi: 10.1016/j.cgh.2017.10.018. \[Epub ahead of print\] 2017 Oct 21 - Publication ### [Racial/ethnic differences in reporting versus rating of healthcare experiences.](https://www.sutterhealth.org/research/publications/racial-differences-in-rating-of-healthcare-experiences-1055312385) Chung S, Mujal G, Liang L, Palaniappan LP, Frosch DL. Medicine (Baltimore). 2018 Dec;97(50):e13604. doi: 10.1097/MD.0000000000013604. 2018 Dec 01 - Publication ### [Heterogeneity of treatment and outcomes among Asians with coronary artery disease in the United States.](https://www.sutterhealth.org/research/publications/treatment-and-outcomes-among-asians-with-cad-in-us-1055312760) Manjunath L, Chung S, Li J, Shah H, Palaniappan L, Yong CM. J Am Heart Assoc. e014362. doi: 10.1161/JAHA.119.014362. \[Epub ahead of print\] 2020 May 11 - Publication ### [Racial and ethnic disparities in opioid prescribing for long bone fractures at discharge from the emergency department: a cross-sectional analysis of 22 centers from a health care delivery system in Northern California.](https://www.sutterhealth.org/research/publications/racial-disparities-opiod-prescribing-for-fractures-in-ed-1055312717) Romanelli RJ, Shen Z, Szwerinski N, Scott A, Lockhart S, Pressman AR. Ann Emerg Med. pii: S0196-0644(19)30417-2. doi: 10.1016/j.annemergmed.2019.05.018. \[Epub ahead of print\] 2019 Jul 01 - Publication ### [Atherosclerotic cardiovascular disease risk prediction in disaggregated Asian and Hispanic subgroups using electronic health records.](https://www.sutterhealth.org/research/publications/cvd-risk-prediction-in-asian-and-hispanic-subgroups-in-ehrs-1055312765) Rodriguez F, Chung S, Blum MR, Coulet A, Basu S, Palaniappan LP. J Am Heart Assoc. 8(14):e011874. doi: 10.1161/JAHA.118.011874. Epub 2019 Jul 11. 2019 Jul 16 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/ursodeoxycholic-acid-treatment-for-biliary-cholangitis-1055312732#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Ursodeoxycholic acid treatment for biliary cholangitis."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/ursodeoxycholic-acid-treatment-for-biliary-cholangitis-1055312732#medicalscholarlyarticle","name":"Ursodeoxycholic acid treatment preferentially improves overall survival among African Americans with primary biliary cholangitis.","headline":"Ursodeoxycholic acid treatment for biliary cholangitis.","abstract":"BACKGROUND: We used data from the Fibrotic Liver Disease Consortium to evaluate the impact of ursodeoxycholic acid (UDCA) treatment across race/ethnicity, gender, and clinical status among patients with primary biliary cholangitis. METHODS: Data were collected from \"index date\" (baseline) through December 31, 2016. Inverse Probability of Treatment Weighting was used to adjust for UDCA treatment selection bias. Cox regression, focusing on UDCA-by-risk factor interactions, was used to assess the association between treatment and mortality and liver transplant/death. RESULTS: Among 4,238 patients with primary biliary cholangitis (13% men; 8% African American, 7% Asian American/American Indian/Pacific Island [ASINPI]; 21% Hispanic), 78% had ever received UDCA. The final multivariable model for mortality retained age, household income, comorbidity score, total bilirubin, albumin, alkaline phosphatase, and interactions of UDCA with race, gender, and aspartate aminotransferase/alanine aminotransferase ≥1.1. Among untreated patients, African Americans and ASINPIs had higher mortality than whites (adjusted hazard ratio [aHR] = 1.34, 95% confidence interval [CI] 1.08-1.67 and aHR = 1.40, 95% CI 1.11-1.76, respectively). Among treated patients, this relationship was reversed (aHR = 0.67, 95% CI 0.51-0.86 and aHR = 0.88, 95% CI 0.67-1.16). Patterns were similar for liver transplant/death. UDCA reduced the risk of liver transplant/death in all patient groups and mortality across all groups except white women with aspartate aminotransferase/alanine aminotransferase ≥1.1. As compared to patients with low-normal bilirubin at baseline (≤0.4 mg/dL), those with high-normal (1.0 > 0.7) and mid-normal bilirubin (0.7 > 0.4) had significantly higher liver transplant/death and all-cause mortality. DISCUSSION: African American and ASINPI patients who did not receive UDCA had significantly higher mortality than white patients. Among African Americans, treatment was associated with significantly lower mortality. Regardless of UDCA treatment, higher baseline bilirubin, even within the normal range, was associated with increased mortality and liver transplant/death compared with low-normal levels.","description":"Among African Americans with primary biliary cholangitis, ursodeoxycholic acid treatment was associated with significantly lower mortality.","keywords":["Health Disparities","Liver Diseases and Transplant","Medical Informatics"],"datePublished":"2020-01-27","url":"https://www.sutterhealth.org/research/publications/ursodeoxycholic-acid-treatment-for-biliary-cholangitis-1055312732","inLanguage":"en-US","identifier":[{"@type":"PropertyValue","propertyID":"PMID","value":"31985529"},{"@type":"PropertyValue","propertyID":"DOI","value":"10.14309/ajg.0000000000000512"}],"sameAs":["https://pubmed.ncbi.nlm.nih.gov/31985529/","https://doi.org/10.14309/ajg.0000000000000512"],"isPartOf":{"@type":"Periodical","name":"Am J Gastroenterol"},"sourceOrganization":{"@type":"MedicalOrganization","name":"Palo Alto Medical Foundation Research Institute"},"about":[{"@type":"DefinedTerm","name":"Health Disparities","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Health+Disparities%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Liver Diseases and Transplant","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Liver+Diseases+and+Transplant%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Medical Informatics","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Medical+Informatics%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/ursodeoxycholic-acid-treatment-for-biliary-cholangitis-1055312732","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/ursodeoxycholic-acid-treatment-for-biliary-cholangitis-1055312732#breadcrumblist"}}} ```