Pretreatment prediction of response to ursodeoxycholic acid in primary biliary cholangitis: development and validation of the UDCA Response Score
Open accessAbstract
Background Current guidelines advocate a step-wise approach to disease-modifying treatment of primary biliary cholangitis (PBC): all patients begin treatment with ursodeoxycholic acid (UDCA) monotherapy – and those with inadequate biochemical response to UDCA are subsequently considered for second-line therapies, the conventional period to demonstrate inadequate UDCA response being 12 months. A potential limitation with this approach, however, is that patients at highest risk end up waiting longest for effective treatment. In this study, we sought to determine whether UDCA response can be accurately predicted using pre-treatment clinical parameters, so that alternative approaches to treatment stratification might be explored. Methods We undertook logistic regression analysis of pre-treatment variables in 2,703 UDCA-treated patients to derive the best-fitting model of UDCA response, defined as ALPT12 < 1.67×ULN. We validated the model in an external PBC cohort from Italy (n=460). Finally, we explored the biological plausibility of the model by looking for correlation between model predictions and key histological features on PBC liver biopsies (n = 20), such as biliary injury and fibrosis. Findings The following pre-treatment parameters were associated with lower probability of UDCA response: higher ALP (p<0.0001), higher bilirubin (p=0.0003), lower transaminases (TA, p=0.0012), younger age (p<0.0001), longer interval from diagnosis to the start of UDCA (treatment time lag, p<0.0001), and worsening of ALP from diagnosis (ΔALP, p<0.0001). Based on these variables, we derived a predictive score of UDCA response: UDCAresponsescore(URS)=0.77+0.60×(TBdiag)−1−2.73×ln(ALPdiag)+0.35×ln(TAdiag)+0.03×age−0.15×(treatmenttimelag)−0.56×ΔALP In external validation, the AUROC was 0.83 (0.79-0.87). In PBC liver biopsies, the URS was associated with ductular reaction (DR) and intermediate hepatocytes (IH). Interpretation We have derived and externally validated a model based on pre-treatment variables that accurately predicts UDCA response. Association with DR and IH provides face validity. Thus, this model provides a basis to explore alternative approaches to treatment stratification in PBC. Fundings Medical Research Council (MR/L001489/1); University of Milan-Bicocca. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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At a population level, UDCA improves serum liver biochemical markers, delays liver transplantation and increases life expectancy.
“At a population level, UDCA improves serum liver biochemical markers, delays liver transplantation and increases life expectancy.21013”
From Optimising Primary thErapy in pRimAry biliary cholangitis (OPERA): protocol for a randomised, double-blind, placebo-controlled trial of enhanced primary therapy with obeticholic acid (2026) · cites this paper as [10]
The Background (page unavailable) says UDCA improves liver biochemistry and transplant-free survival in patients with primary biliary cholangitis. Transplant-free survival is a combined outcome; the passage does not separately establish that UDCA delays transplantation and increases life expectancy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredTherapy delay in PBC leads to a significantly reduced likelihood that the therapy will work when eventually used.
“UK-PBC studies have demonstrated that therapy delay in PBC leads to a significantly reduced likelihood that the therapy will work when eventually used.10”
From Optimising Primary thErapy in pRimAry biliary cholangitis (OPERA): protocol for a randomised, double-blind, placebo-controlled trial of enhanced primary therapy with obeticholic acid (2026) · cites this paper as [10]
The Results (Identification of variables that predict UDCA response; page not supplied) report that a shorter treatment time lag predicted response to UDCA. The Discussion (page not supplied) says delayed treatment was associated with inadequate response and may reduce the likelihood of responding. The claim overstates that association as a demonstrated causal effect and extends it from UDCA to therapy generally. (LLM, conf=0.87)
Experimental — accuracy not yet measuredIn PBC, UDCA treatment failure can be accurately predicted by pretreatment clinical parameters including age and serum biochemistry.
“studies from UK-PBC have clearly shown that UDCA treatment failure can be accurately predicted by pretreatment clinical parameters including the patient’s age and serum biochemistry.10”
The likelihood of response to UDCA can be predicted with accuracy at the outset of disease, and algorithms have been developed to allow prediction in practice.
“It is clear, however, that the likelihood of response to UDCA can be predicted with accuracy at the outset of disease, and algorithms developed to allow prediction in practice.10”
A predictive model of response to ursodeoxycholic acid treatment was developed based on pretreatment clinical factors and biochemistries and was validated in other cohorts.
“A predictive model of response to ursodeoxycholic acid treatment was developed based on pretreatment clinical factors and biochemistries, 121 and was validated in other cohorts.122,123”
From Primary biliary cholangitis. (2024) · cites this paper as [121]
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Self-citationYagi, M., Matsumoto, K., Komori, A., Abe, M., Hashimoto, N., Inao, M., Namisaki, T., Kawata, K., Ninomiya, M., Fujii, H., et al. (2020) · Liver International · doi:10.1111/liv.14534 · Cited by 20 · see citing works
Gut microbiome pattern impacts treatment response in primary biliary cholangitis
Liu, Q., Huang, B., Zhou, Y., Wei, Y., Li, Y., Li, B., Li, Y., Zhang, J., Qian, Q., Chen, R., et al. (2024) · Med · doi:10.1016/j.medj.2024.08.003 · Cited by 20 · see citing works
Gerussi, A., D’Amato, D., Cristoferi, L., O’Donnell, S. E., Carbone, M., & Invernizzi, P. (2019) · Annals of Hepatology · doi:10.1016/j.aohep.2019.09.009 · Cited by 20 · see citing works
Self-citationEmerging novel treatments for autoimmune liver diseases
Tanaka, A. (2019) · Hepatology Research · doi:10.1111/hepr.13347 · Cited by 19 · see citing works
Yu, K., Li, P., Xu, T., Xu, J., Wang, K., Chai, J., Zhao, D., Liu, Y., Wang, Y., Ma, J., et al. (2020) · Pathology - Research and Practice · doi:10.1016/j.prp.2020.153291 · Cited by 17 · see citing works
Primary biliary cholangitis and the narrowing gap towards optimal disease control
Cançado, G. G. L., Lleò, A., Levy, C., Trauner, M., & Hirschfield, G. M. (2025) · The Lancet. Gastroenterology & hepatology · doi:10.1016/s2468-1253(25)00025-1 · Cited by 19 · see citing works
Self-citationDistinct EpCAM-Positive Stem Cell Niches Are Engaged in Chronic and Neoplastic Liver Diseases
Safarikia, S., Carpino, G., Overi, D., Cardinale, V., Venere, R., Franchitto, A., Onori, P., Alvaro, D., & Gaudio, E. (2020) · Frontiers in Medicine · doi:10.3389/fmed.2020.00479 · Cited by 16 · see citing works
Self-citationKawata, K., Joshita, S., Shimoda, S., Yamashita, Y., Yamashita, M., Kitsugi, K., Takatori, S., Ohta, K., Ito, J., Shimoyama, S., et al. (2020) · Hepatology Research · doi:10.1111/hepr.13584 · Cited by 16 · see citing works
Autoantibodies in Primary Biliary Cholangitis
Leung, K. K., & Hirschfield, G. M. (2022) · Clinics in Liver Disease · doi:10.1016/j.cld.2022.06.004 · Cited by 15 · see citing works
Self-citationReasons why women are more likely to develop primary biliary cholangitis
Ma, D., Ma, J., Zhao, C., & Tai, W. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e25634 · Cited by 14 · see citing works
Carbone, M., Gerussi, A., Cardinale, V., Cazzagon, N., Cossiga, V., Lleò, A., Marrone, G., Marzioni, M., Moschetta, A., Muratori, L., et al. (2024) · Digestive and Liver Disease · doi:10.1016/j.dld.2024.05.002 · Cited by 16 · see citing works
Self-citationKimura, N., Takamura, M., Takeda, N., Watanabe, Y., Arao, Y., Takatsuna, M., Takeuchi, S., Abé, H., Setsu, T., Kamimura, H., et al. (2021) · Hepatology International · doi:10.1007/s12072-021-10163-0 · Cited by 14 · see citing works
Current and promising therapy for primary biliary cholangitis
Gossard, A. A., & Lindor, K. D. (2019) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2019.1601701 · Cited by 15 · see citing works
Liang, Y., Li, J., Zhang, Z., Jiang, T., & Yang, Z. (2024) · Clinics and Research in Hepatology and Gastroenterology · doi:10.1016/j.clinre.2024.102321 · Cited by 14 · see citing works
Vincentis, A. D., Ampuero, J., Terracciani, F., D’Amato, D., Gerussi, A., Cristoferi, L., Cazzagon, N., Bonaiuto, E., Floreani, A., Calvaruso, V., et al. (2024) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2024.05.008 · Cited by 12 · see citing works
Self-citationWiegand, J., Franke, A., Müller, T., Stein, K., Bantel, H., Günther, R., Denk, G., Reuken, P. A., Schattenberg, J. M., Naumann, U., et al. (2024) · Zeitschrift für Gastroenterologie · doi:10.1055/a-2382-7720 · Cited by 12 · see citing works
Giannini, E. G., Pieri, G., Labanca, S., Torres, M. C. P., Gasbarrini, A., Biasini, E., Campani, C., Cazzagon, N., Foschi, F. G., Mega, A., et al. (2022) · Digestive and Liver Disease · doi:10.1016/j.dld.2022.03.002 · Cited by 12 · see citing works
Self-citationThe Inconvenient Truth of Primary Biliary Cholangitis/Autoimmune Hepatitis Overlap Syndrome
Hussain, N., & Trivedi, P. J. (2022) · Clinics in Liver Disease · doi:10.1016/j.cld.2022.06.007 · Cited by 14 · see citing works
Matsumoto, K., Hirohara, J., Takeuchi, A., Miura, R., Asaoka, Y., Nakano, T., & Tanaka, A. (2023) · Hepatology Research · doi:10.1111/hepr.13931 · Cited by 12 · see citing works
Namisaki, T., Fujinaga, Y., Moriya, K., & Yoshiji, H. (2020) · Hepatology Research · doi:10.1111/hepr.13593 · Cited by 11 · see citing works
Letter: histology is relevant for risk stratification in primary biliary cholangitis
Carbone, M., D’Amato, D., Hirschfield, G. M., Jones, D. E., & Mells, G. F. (2019) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.15583 · Cited by 11 · see citing works
Self-citationThe treatment of primary biliary cholangitis: from shadow to light
Dražilová, S., Koky, T., Macej, M., Janíčko, M., Simkova, D., & Jarčuška, P. (2024) · Therapeutic Advances in Gastroenterology · doi:10.1177/17562848241265782 · Cited by 10 · see citing works
Li, J., Lü, M., Zhou, Y., Bowlus, C. L., Lindor, K. D., Rodriguez‐Watson, C., Romanelli, R. J., Haller, I. V., Anderson, H., VanWormer, J. J., et al. (2021) · Digestive Diseases and Sciences · doi:10.1007/s10620-021-07219-4 · Cited by 10 · see citing works
Chang, J.-I., Kim, J. H., Sinn, D. H., Cho, J., Kim, K. M., Oh, J. H., Park, Y., Sohn, W., Goh, M. J., Kang, W., et al. (2023) · Gut and Liver · doi:10.5009/gnl220420 · Cited by 10 · see citing works
The latest research trends in primary biliary cholangitis: a bibliometric analysis
Zhao, Y., Yin, Z., Du, H., Huang, K., Zhang, F., & Chen, H. (2022) · Clinical and Experimental Medicine · doi:10.1007/s10238-022-00825-0 · Cited by 9 · see citing works
Risk Stratification in Primary Biliary Cholangitis
Martini, F., Balducci, D., Mancinelli, M., Buzzanca, V., Fracchia, E., Tarantino, G., Benedetti, A., Marzioni, M., & Maroni, L. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12175713 · Cited by 9 · see citing works
Self-citationPrognostic models and autoimmune liver diseases
D’Amato, D., & Carbone, M. (2023) · Best Practice & Research Clinical Gastroenterology · doi:10.1016/j.bpg.2023.101878 · Cited by 10 · see citing works
Self-citationPrecision medicine in primary biliary cholangitis
Ronca, V., Gerussi, A., Cristoferi, L., Carbone, M., & Invernizzi, P. (2019) · Journal of Digestive Diseases · doi:10.1111/1751-2980.12787 · Cited by 9 · see citing works
Self-citationChang, M., Chen, W., Chan, T., Lin, C.-Y., Chang, M.-Y., Chen, S.-C., & Chien, R. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.869018 · Cited by 9 · see citing works
Kimura, N., Takahashi, K., Setsu, T., Horibata, Y., Kaneko, Y., Miyazaki, H., Ogawa, K., Kawata, Y., Sakai, N., Watanabe, Y., et al. (2023) · Hepatology Research · doi:10.1111/hepr.13966 · Cited by 8 · see citing works
Cançado, G. G. L., Fucuta, P. D. S., Gomes, N. M. D. F., Couto, C. A., Cançado, E. L. R., Terrabuio, D. R. B., Villela‐Nogueira, C. A., Braga, M. H., Nardelli, M. J., Faria, L. C., et al. (2024) · Clinics and Research in Hepatology and Gastroenterology · doi:10.1016/j.clinre.2024.102453 · Cited by 8 · see citing works
The Treatment of Primary Biliary Cholangitis: Time for Personalized Medicine
Men, X., Liu, Y., Zhao, H., Xie, B., Guo, C., Leung, P. S. C., Timilsina, S., Gershwin, M. E., Shang, Y., & Han, Y. (2025) · Clinical Reviews in Allergy & Immunology · doi:10.1007/s12016-025-09074-x · Cited by 8 · see citing works
Bossen, L., Lau, T. S., Nielsen, M. B., Nielsen, M. C., Andersen, A. H., Ott, P., Becker, S., Glerup, H., Svenningsen, L., Eivindson, M., et al. (2023) · Hepatology Communications · doi:10.1097/hc9.0000000000000068 · Cited by 8 · see citing works
Patient ownership of primary biliary cholangitis long-term management
Leighton, J., Thain, C., Mitchell-Thain, R., Dyson, J. K., & Jones, D. E. J. (2020) · Frontline Gastroenterology · doi:10.1136/flgastro-2019-101324 · Cited by 8 · see citing works
Self-citationKnockout of secretin ameliorates biliary and liver phenotypes during alcohol-induced hepatotoxicity
Kyritsi, K., Wu, N., Zhou, T., Carpino, G., Baiocchi, L., Kennedy, L. L., Chen, L., Ceci, L., Meyer, A., Barupala, N. P., et al. (2023) · Cell & Bioscience · doi:10.1186/s13578-022-00945-w · Cited by 8 · see citing works
Self-citationInvestigational drugs in early phase development for primary biliary cholangitis
Gochanour, E. M., & Kowdley, K. V. (2020) · Expert Opinion on Investigational Drugs · doi:10.1080/13543784.2021.1857364 · Cited by 8 · see citing works
Terracciani, F., Vincentis, A. D., D’Amato, D., Cristoferi, L., Gerussi, A., Invernizzi, P., Scaravaglio, M., Vanni, E., Campion, D., Morgando, A., et al. (2025) · JHEP Reports · doi:10.1016/j.jhepr.2025.101448 · Cited by 7 · see citing works
Self-citationPrimary biliary cholangitis: current insights and novel therapies
Granito, A., Παππάς, Γ., Napoli, L., Stefanini, B., Tirotta, D., & Muratori, P. (2026) · Expert Review of Clinical Immunology · doi:10.1080/1744666x.2026.2672493 · Cited by 8 · see citing works
Huang, L., Wang, Z.-L., Jin, R., Chen, H.-S., & Feng, B. (2022) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2022.2153672 · Cited by 7 · see citing works
Xie, X., Huang, R., Zhang, W., & Zhang, R. (2024) · International Journal of Biological Macromolecules · doi:10.1016/j.ijbiomac.2024.136328 · Cited by 7 · see citing works
Primary biliary cholangitis (PBC): evolving approaches and expert perspectives
Invernizzi, P., Aghemo, A., Calvaruso, V., Lleò, A., Marzioni, M., Piscaglia, F., Rigamonti, C., Gentilucci, U. V., Brillanti, S., Carbone, M., et al. (2025) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2025.2601220 · Cited by 6 · see citing works
Self-citationPredictive Model of Ursodeoxycholic Acid Treatment Response in Primary Biliary Cholangitis
Shu, Y.-Y., Song, Y., Bai, T., Pan, X., Shang, H., Yang, L., Ye, J., & Du, F. (2021) · Journal of Clinical and Translational Hepatology · doi:10.14218/jcth.2020.00127 · Cited by 6 · see citing works
Gazda, J., Dražilová, S., Janíčko, M., Grgurević, I., Kanižaj, T. F., Koller, T., Bodorovska, B., Božin, T., Mijić, M., Rob, Z., et al. (2021) · Journal of Personalized Medicine · doi:10.3390/jpm11060495 · Cited by 6 · see citing works
Gazda, J., Janicko, M., Drazilova, S., Grgurevic, I., Kanizaj, T. F., Koller, T., Bodorovska, B., Mijic, M., Mikolasevic, I., Stromar, I. K., et al. (2021) · Canadian Journal of Gastroenterology and Hepatology · doi:10.1155/2021/9928065 · Cited by 6 · see citing works
Yehezkel, E., Israel, I., Houri, I., Leshno, M., Shibolet, O., & Zigmond, E. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10194551 · Cited by 6 · see citing works
Review Article: Targeting Peroxisome Proliferator‐Activated Receptors in Primary Biliary Cholangitis
Schattenberg, J. M., Bañales, J. M., Hirschfield, G. M., Trivedi, P., Cable, E. E., McWherter, C. A., Billin, A. N., Crittenden, D. B., & Budas, G. R. (2026) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.70598 · Cited by 5 · see citing works
Self-citationPrognostic Scoring Systems in Primary Biliary Cholangitis: An Update.
Scaravaglio, M., & Carbone, M. (2022) · Clinical Liver Disease · doi:10.1016/j.cld.2022.06.005 · Cited by 4 · see citing works
Self-citationPrimary biliary cholangitis: perception and expectation of illness
Floreani, A., Scaffidi, M., Coco, B. A., Giannini, E. G., Labanca, S., Bonaiuto, E., Martin, S. D., Invernizzi, P., Carbone, M., Alvaro, D., et al. (2022) · Digestive and Liver Disease · doi:10.1016/j.dld.2022.02.006 · Cited by 5 · see citing works
Self-citationGerussi, A., & Carbone, M. (2020) · doi:10.1002/9781119532637.ch7 · Cited by 5 · see citing works
Self-citationReviewing novel findings and advances in diagnoses and treatment of primary biliary cholangitis
Floreani, A., Gabbia, D., & Martin, S. D. (2025) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2025.2537192 · Cited by 4 · see citing works
Self-citationWetten, A., Jones, D. E. J., & Dyson, J. K. (2021) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2021.1940135 · Cited by 4 · see citing works
Self-citationScaravaglio, M., Carbone, M., & Invernizzi, P. (2023) · Minerva Gastroenterology · doi:10.23736/s2724-5985.22.03279-x · Cited by 4 · see citing works
Self-citationPrognostic scores in primary biliary cholangitis
Tababi, R., Mrabet, S., Akkari, I., Harbi, R., & Jazia, E. B. (2024) · Future Science OA · doi:10.2144/fsoa-2023-0203 · Cited by 4 · see citing works
- Authors
- Carbone, M., Nardi, A., Flack, S., Carpino, G., Varvaropoulou, N., Gavrila, C., Spicer, A., Badrock, J., Bernuzzi, F., Cardinale, V., Ainsworth, H. F., Heneghan, M. A., Thorburn, D., Bathgate, A., Jones, R., Neuberger, J. M., Battezzati, P. M., Zuin, M., Taylor-Robinson, S., Donato, M. F., Kirby, J., Mitchell-Thain, R., Floreani, A., Sampaziotis, F., Muratori, L., Alvaro, D., Marzioni, M., Miele, L., Marra, F., Giannini, E., Gaudio, E., Ronca, V., Bonato, G., Cristoferi, L., Malinverno, F., Gerussi, A., Stocken, D. D., Cordell, H. J., Hirschfield, G. M., Alexander, G. J., Sandford, R. N., Jones, D. E., Invernizzi, P., Mells, G. F., Thomas, C., Rahman, M., Yapp, T., Lye Ch'ng, C., Harrison, M., Sturgess, R., Galaska, R., Healey, C., Whiteman, J., Czaijkowski, M., Gray, C., Gunasekera, A., Gyawli, P., Premchand, P., Mann, S., Elliott, K., Kapur, K., Watson, A., Foster, G., Trembling, P., Subhani, J., Harvey, R., McCorry, R., Adgey, C., Hobson, L., Mulvaney-Jones, C., Evans, R., Mathialahan, T., Ramanaden, D., Gasem, J., Van Duyvenvoorde, G., Shorrock, C., Seward, K., Southern, P., Tibble, J., Penn, R., Gorard, D., Maiden, J., Damant, R., Palegwala, A., Jones, S., Alexander, G., Mells, G., Sandford, R., Whiteman, J., Dolwani, S., Prince, M., Silvestre, V., Foxton, M., Dungca, E., Mitchison, H., Wheatley, N., Gooding, I., Doyle, H., Karmo, M., Kent, M., Saksena, S., Braim, D., Patel, M., Lord, S., Ede, R., Paton, A., Austin, A., Lancaster, N., Sayer, J., Gibbins, A., Hogben, K., Hovell, C., Fisher, N., Carter, M., Koss, K., Musselwhite, J., Muscariu, F., Piotreowicz, A., McKay, A., Grimley, C., Neal, D., Ting Tan, L., Lim, G., Brighton, J., Foale, C., Ala, A., Saeed, A., Flahive, K., Wood, G., Townshend, P., Ford, C., Brown, J., Kordula, J., Bowles, J., Wilkinson, M., Palmer, C., Ramage, J., Gordon, H., Featherstone, J., Ridpath, J., Ngatchu, T., Levi, S., Shaukat, S., Sadeghian, J., Shidrawi, R., Williams, B., Abouda, G., Jones, S., Duggan, C., Hynes, A., Narain, M., Rees, I., Salam, I., Crossey, M., Taylor-Robinson, S., Brown, A., MacNicol, C., Williams, S., Wilhelmsen, E., Banim, P., Raymode, P., Chilton, A., Das, D., Lee, H.-J., Curtis, H., Heneghan, M., Gess, M., Durant, E., Drake, I., Bishop, R., Davies, M., Jones, R., Aldersley, M., Ncube, N., McNair, A., Srirajaskanthan, R., Sen, S., Casey, R., Bird, G., Mendall, M., Cowley, C., Barnardo, A., Kitchen, P., Yoong, K., Amore, K., Sirdefield, D., Orpe, J., Mathew, R., MacFaul, G., Wrigth, A., Shah, A., Evans, C., Keggans, J., Bird, B., Baxter, G., Saha, S., Pollock, K., Hughes, M., Bramley, P., Grieve, E., Young, K., Fraser, A., Mukhopadhya, A., Ocker, K., Mills, P., Hines, F., Shallcross, C., Wilkins, J., Grellier, L., Campbell, S., Martin, K., Bathgate, A., Innes, C., Shepherd, A., Rushbrook, S., Valliani, T., Przemioslo, R., Fairlamb, H., Macdonald, C., Eastick, A., Metcalf, J., Tanqueray, E., Shmueli, U., Holbrook, B., Davis, A., Browning, J., Naqvi, A., Walker, K., Lee, T., Verheyden, J., Slininger, S., Ryder, S. D., Chapman, R., Collier, J., O'Donnell, D., Stafford, L., Williamson, K., Kent, L., Klass, H., Ninkovic, M., March, L., Cramp, M., Simpson, D., Dickson, C., Sharer, N., Hayes, M., Goggin, P., Quinne, M., Pearson, S., Hoeroldt, B., Jones, L., Wright, A., Booth, J., Loftus, A., Lipscomb, G., Dewhurst, H., Gunter, E., Williams, E., Fouracres, A., Farrington, L., Graves, L., Hussaini, H., Stableforth, B., Marriott, S., Ayres, R., Leoni, M., Burroughs, A., Marshall, E., Thorburn, D., Tyrer, D., Martin, K., Lombard, M., Patanwala, I., Dali-Kemmery, L., Lambourne, V., Maltby, J., Vyas, S., Colley, J., Shinder, B., Singhal, S., Jones, J., Mills, M., Gleeson, D., Carnahan, M., Butterworth, J., Boulton, K., Taylor, N., George, K., Harding, T., Tregonning, J., Douglass, A., Brown, C., Clifford, G., Panter, S., Gocher, D., Shearman, J., Bray, G., Hamilton, M., Butcher, G., Forton, D., Mclindon, J., Curtis, J., Das, D., Shewan, T., Cowan, M., Whatley, G., Nasseri, M., Grover, B., Sivaramakrishnan, N., Ducker, S., Houghton, K., Jones, D., Griffiths, L., Tripoli, S., Pitcher, M., Shpuza, E., White, N., Ghosh, D., Douds, A., Green, M., Brookes, M., Cumlat, L., Wong, V. S., Warner, K., Netherton, K., Mandal, A., Jain, S., Gupta, H., Sanghi, P., Pereira, S., Neuberger, J., Gunson, B., Hirschfield, G., Lim, R. T., Gallagher, S., Clement, D., Brind, A., Watts, G., Mupudzi, M., Wright, M., Gitahi, J., Gordon, F., Gocher, D., Unitt, E., Pateman, H., Batham, S., Delahooke, T., Grant, A., Conder, J., Higham, A., Cox, M., O'Donohoe, L., Currie, L., King, A., Oblak, M., Collins, C., Whalley, S., Quinn, M., Baird, Y., Amey, I., Fraser, J., Li, A., Cotterill, D., Bell, A., Watson, A., Singhal, A., Gee, I., Greer, S., Ang, Y., Ransford, R., Allison, J., Gotto, J., Dyer, S., Sweeting, H., Millson, C., Invernizzi, P., Carbone, M., Cristoferi, L., Bonato, G., Malinverno, F., Bernuzzi, F., Alvaro, D., Labbadia, G., Bragazzi, M. C., Andreone, P., Muratori, L., Azzaroli, F., Floreani, A., Galli, A., Tarocchi, M., Giannini, E., Miele, L., Gasbarrini, A., Grieco, A., Marrone, G., Donato, M. F., Valenti, L., Marra, F., Marzioni, M., Maroni, L., Rigamonti, C., Zuin, M., Battezzati, P. M., & Picciotto, A.
- Affiliations
- University of Rome Tor Vergata (IT)
- University of Cambridge (GB)
- Foro Italico University of Rome (IT)
- Sapienza University of Rome (IT)
- Newcastle University (GB)
- PBC Foundation (GB)
- Wellcome/MRC Cambridge Stem Cell Institute (GB)
- Ospedale San Paolo (IT)
- University of Milano-Bicocca (IT)
- Edinburgh Royal Infirmary (GB)
- Queen Elizabeth Hospital Birmingham (GB)
- Imperial College London (GB)
- St James's University Hospital (GB)
- University of Milan (IT)
- University of Padua (IT)
- Agostino Gemelli University Polyclinic (IT)
- ORCID
- Nardi, Alessandra
- Carpino, Guido
- Cardinale, Vincenzo
- Kirby, John
- Mitchell-Thain, Robert
- Sampaziotis, Fotios
- Gaudio, Eugenio
- Ronca, Vincenzo
- Gerussi, Alessio
- Stocken, Deborah D
- Cordell, Heather J
- Gray, Catherine
- Kapur, Kapil
- Foster, Graham
- Trembling, Paul
- Tibble, Jeremy
- Dolwani, Sunil
- Fisher, Neil
- Ala, Aftab
- Brown, Jonathan
- Wilkinson, Mark
- Palmer, Caroline
- Ramage, John
- Shidrawi, Ray
- Williams, Bronwen
- Jones, Sarah
- Banim, Paul
- Das, Debasish
- Lee, Hye-Jeong
- Aldersley, Mark
- Ncube, Noma
- Cowley, Caroline
- MacFaul, George
- Fraser, Andrew
- Mills, Peter
- Grellier, Leonie
- Campbell, Stewart
- Rushbrook, Simon
- Valliani, Talal
- Przemioslo, Robert
- Lee, Tom
- Ryder, Stephen D
- Chapman, Roger
- Collier, Jane
- Stafford, Lizzie
- Cramp, Matthew
- Hoeroldt, Barbara
- Jones, Linda
- Dewhurst, Hannah
- Burroughs, Andrew
- Patanwala, Imran
- Gleeson, Dermot
- George, Keith
- Harding, Tim
- Clifford, Gayle
- Forton, Daniel
- Cowan, Matthew
- Ghosh, Deb
- Douds, Andrew
- Brookes, Matthew
- Gupta, Hemant
- Gunson, Bridget
- Wright, Mark
- Gordon, Fiona
- Batham, Sally
- Collins, Carole
- Whalley, Simon
- Singhal, Amit
- Ang, Yeng
- Millson, Charles
- Labbadia, Giancarlo
- Bragazzi, Maria Consiglia
- Azzaroli, Francesco
- Galli, Andrea
- Tarocchi, Mirko
- Gasbarrini, Antonio
- Grieco, Antonio
- Marrone, Giuseppe
- Valenti, Luca
- Maroni, Luca
- Rigamonti, Cristina
- Venue
- The Lancet Gastroenterology & Hepatology
- Publisher
- Elsevier BV
- Published
- 2018-09
- Volume
- 3
- Issue
- 9
- Pages
- 626-634
- ISSN
- 2468-1156 (ISSN-L)
- 2468-1253
- PMC
- PMC6962055
- OpenAlex
- W2883784290
- Semantic Scholar
- cd10e32484b0f06ad9d9e15fe1b21304b3b08b07
- Cited by
- 155
- References
- 26
- Citations by year
- 2026: 9 · 2025: 18 · 2024: 20 · 2023: 23 · 2022: 19 · 2021: 23 · 2020: 23 · 2019: 15 · 2018: 4 · 2017: 1
- FWCI
- 10.18
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Lancet. Gastroenterology & hepatology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion, other-oa)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion, other-oa)
- Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, other-oa)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (submittedVersion)
- Florence Research (University of Florence) (submittedVersion)
- CINECA IRIS Institutial Research Information System (University of Genoa) (submittedVersion)
- IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
- Università Politecnica delle Marche (Università Politecnica delle Marche) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion, other-oa)
- Spiral (Imperial College London) (submittedVersion, cc-by-nc-nd)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Apollo (University of Cambridge) (submittedVersion)
- Padua Research Archive (University of Padova) (submittedVersion)
- Apollo
- Funders
- Wellcome Trust (085925)
- NIHR Imperial Biomedical Research Centre
- Intercept Pharmaceuticals
- Birmingham Biomedical Research Centre
- Medical Research Council (MR/L001489/1)
- NIHR Nottingham Biomedical Research Centre
- National Institute for Health and Care Research
- Isaac Newton Trust
- Università degli Studi di Milano-Bicocca
- Topics
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Health Sciences › Medicine › Surgery › Pediatric Hepatobiliary Diseases and Treatments
- Health Sciences › Medicine › Oncology › Drug Transport and Resistance Mechanisms
- Keywords
- primary biliary cirrhosis, ursodeoxycholic acid, alkaline phosphatase, total bilirubin, transaminases, liver biopsy histology, ductular reaction, liver fibrosis, biliary injury, second-line therapy, external validation
- MeSH terms
- Alkaline Phosphatase, Transaminases, Bilirubin, Cholagogues and Choleretics, Decision Support Techniques, Female, Humans, Liver Cirrhosis, Biliary, Male, Middle Aged, Risk Factors, ROC Curve, Ursodeoxycholic Acid, Linear Models, Treatment Outcome, Age of Onset, Area Under Curve, Time-to-Treatment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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