Risk stratification for those newly diagnosed with primary biliary cholangitis may be best accomplished through the use of the recently developed and validated UK-PBC scoring system, according to a short review published in Hepatology.
Dr. Bertus Eksteen of the Snyder Institute for Chronic Diseases at the University of Calgary (Alta.) described not only the importance of prompt risk assessment in order to prioritize who should receive therapy and be appropriately counseled, but also the difficulties presented by the current risk stratification scoring systems (Hepatology. 2016 Mar;63:697-9).
In his review, Dr. Eksteen asserts that the primary challenge for clinicians attempting to manage patients with primary biliary cholangitis is the selection of those at risk for disease progression. This assessment is of critical importance, as it informs clinical decision making regarding whether to initiate therapy or avoid it.
The review is partially focused on the advantages and disadvantages associated with the use of the multiple clinical and biochemical parameters that have been used to predict progression in primary biliary cholangitis to date. Additionally, the relative strengths and weaknesses of the UK-PBC scoring system are described.
According to Dr. Eksteen, the UK-PBC risk score represents the most complete tool for the assessment of risk of primary biliary cholangitis progression that can be used for clinical patient counseling. Furthermore, the UK-PBC is described as a scoring system with the potential to become a surrogate marker for primary biliary cholangitis progression and should be factored into the design of clinical trials for new agents in development.
The main limitation associated with the use of the UK-PBC risk score is that certain portions contributing to the overall score require at least 12 months of therapy with the only approved treatment for primary biliary cholangitis, ursodeoxycholic acid. This is problematic, as it does not provide the baseline thresholds necessary in order to prioritize patients for therapy, Dr. Eksteen said.
Despite its main limitation, Dr. Eksteen described this scoring system as extremely timely and valuable in the risk assessment of those with primary biliary cholangitis.
No external funding source was disclosed. Dr. Eksteen reported no conflicts of interest.