Study finds ethnic disparities in common liver disease treatment
Hispanic patients with PBC less likely to achieve lab remission
Written by |
Hispanic people with primary biliary cholangitis (PBC) are significantly less likely to achieve complete lab-based remission — defined as a normalization of the liver damage marker alkaline phosphatase (ALP) — after ursodeoxycholic acid (UDCA) treatment than non-Hispanic white patients.
That’s according to a U.S. study that showed non-white patients were also less likely to have a good lab-based response to UDCA, the first-line treatment for PBC, relative to non-Hispanic white patients. These poor responses were observed despite comparable blood ALP levels at the start of UDCA across races and ethnicities.
“These findings highlight the need to identify and address factors that influence treatment response across broader PBC populations,” the researchers wrote. “Future studies should explore the underlying contributors driving these differences and identify strategies to improve long-term outcomes for all populations with PBC.”
The study, “Alkaline Phosphatase Normalization Occurs Less Frequently in Hispanic Patients With Primary Biliary Cholangitis,” was published in Clinical Gastroenterology and Hepatology.
PBC is a chronic form of cholangitis characterized by inflammation of the bile ducts, the tubes that carry the digestive fluid bile from the liver to the intestines. This can slow bile flow and cause bile to accumulate to toxic levels in the liver, leading to liver scarring (fibrosis).
Data on diverse populations lacking
UDCA, sold under the brand names Urso and Actigall, is used to help bile flow more easily and prevent further liver damage. However, “a substantial proportion of patients have incomplete biochemical [lab-based] response and remain at risk for progression,” the researchers wrote.
Research increasingly suggests differences in PBC presentation and treatment response across racial and ethnic groups, but “most existing PBC outcome data derive from predominantly non-Hispanic White (NHW) [groups] of Northern European descent, limiting the generalizability of clinical trial data and treatment guidelines to the diverse US population,” the researchers wrote.
The team evaluated racial and ethnic differences in rates of complete biochemical remission with UDCA, with a focus on Hispanic populations. Complete biochemical remission was defined as a normalization of blood levels of ALP, a liver enzyme that is elevated in people with PBC.
They retrospectively analyzed data from 427 PBC patients (94.4% women; median age, 57) who were followed at two U.S. hospitals serving predominantly Hispanic patient populations. Most participants (66%) were Hispanic, followed by non-Hispanic whites (22.5%) and other populations of non-white patients (11.5%).
Hispanic patients were significantly more likely to be born in a foreign country (52.8% vs. 10.4%), and to be underinsured (64.5% vs. 16.7%), and unemployed (64.9% vs. 25%) than non-Hispanic white patients. Similar patterns were observed for all non-white patients.
Hispanic patients were also significantly more likely to have metabolic dysfunction-associated steatotic liver disease (MASLD; 23.8% vs. 12.5%) and PBC-autoimmune hepatitis overlap syndrome (PBC-AIH; 19.9% vs. 9.4%).
MASLD is marked by excess fat in the liver, typically in association with cardiometabolic risk factors, such as obesity or diabetes. PBC-AIH exhibits both features of PBC and of autoimmune hepatitis, where liver inflammation is caused by immune attacks against healthy liver cells.
Overall, both the Hispanic group and the larger non-white group showed significantly higher blood levels of ALP and other liver damage markers than the non-Hispanic white group. Still, rates of irreversible liver damage (cirrhosis) and symptoms of severe liver disease were similar across groups.
Data from 158 patients with one year of follow-up were included in the analysis of complete biochemical remission. Here, blood ALP levels at the initiation of UDCA treatment were similar between all races and ethnicities.
However, statistical analyses adjusted for potential influencing factors showed that after one year of treatment, Hispanic patients were significantly less likely, by 69%, to achieve ALP normalization than non-Hispanic white patients.
Non-white patients also had 77% lower odds of experiencing ALP normalization after a year compared with non-Hispanic white patients.
Over a median follow-up period of more than three years, 20.6% of all participants underwent liver transplantation or died. Among those without liver decompensation (where the liver no longer works properly) at presentation, 18.6% experienced a liver decompensation event.
The proportion of patients who lived five years without needing a liver transplant or experiencing a liver decompensation event was not significantly different between the groups. However, Hispanic and non-white patients showed a trend toward a higher rate of liver decompensation events.
“These findings highlight the need for targeted interventions, improved health care access, responsive patient education, and greater inclusion of diverse populations in clinical trials,” the researchers wrote.
