Elevated Alk Phos

Ursodiol Plus Methotrexate Effective Long Term in Biliary Cirrhosis

Combination therapy consisting of ursodiol and either methotrexate or colchicine for primary biliary cirrhosis showed long-term effectiveness, lasting up to 20 years, wrote Dr. John Leung and his colleagues in the September issue of Clinical Gastroenterology and Hepatology (doi:10.1016/j.cgh.2011.05.010).

Dr. Leung, of the department of gastroenterology at Tufts Medical Center, Boston, and his colleagues studied 29 patients with primary biliary cirrhosis, a chronic progressive disease thought to have an autoimmune etiology. The patients were originally part of an 85-patient, double-blind, prospective, randomized controlled trial comparing colchicine and methotrexate from 1988 to 2000, with ursodiol (ursodeoxycholic acid) added to that regimen 3 years after study initiation.

The patients examined in the current study had completed all 10 years of follow-up in the original trial. At completion, "the randomization code was broken and these 29 patients were treated according to their clinical response, personal preference, and tolerance to therapy."

They were then followed for an additional 9-13 years, either at the authors’ institution (21 patients) or via telephone calls and e-mail correspondence with referring physicians.

All patients except one were female, and the median age at the end of the initial 10-year randomized controlled trial (RCT) was 59 years.

According to the authors, of the 29 patients followed for 20 years, "Twenty-one patients are alive and well. Of these, 19 have normal tests of liver function and no signs of portal hypertension."

The outcomes were then analyzed by specific treatment regimen. Of the 11 patients on methotrexate plus ursodiol, "2 died of causes unrelated to liver disease at the age of 79 and 70, and 9 are alive and well," reported the authors. All nine of these patients have normal serum levels of alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase, and bilirubin.

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Hi everyone.  I had a liver resection about  3.5 months ago.  My LFT's were normal prior to the resection, then they spiked after the surgery and have been coming down and are pretty much normal...Except for my Alk Phos.  It is rising.  Last week it was 400 and now is 600.  My oncologist was not concerned about the Alk Phos since I just had a 3 month MRI which was normal. But I am concerned.  Anyone have any experience with this?

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