This umbrella meta-analysis of meta-analyses looked at how different treatments affect primary biliary cholangitis. The review included data from 3,276 patients after removing duplicate randomized trials found across multiple studies. The researchers compared combination therapy of fibrates with ursodeoxycholic acid against ursodeoxycholic acid alone, as well as fibrate monotherapy.
The main results showed that the combination approach led to better biochemical responses. Alkaline phosphatase levels dropped by an average of 85.4 units per liter, and bilirubin levels decreased by 0.45 milligrams per deciliter compared to ursodeoxycholic acid alone. Treatment response rates were also higher with the combination. Fibrates used alone also improved these markers, though to a lesser extent.
Safety concerns included adverse events in 12 to 18 percent of patients, mostly mild itching and gastrointestinal symptoms. No serious adverse events were reported, and discontinuations were not detailed. However, the evidence on survival and transplant-free outcomes remains insufficient. The methodological quality of the included studies ranged from moderate to high, and there was significant overlap between the meta-analyses. Readers should understand that while biochemical markers improved, long-term survival benefits are not yet confirmed.
