TY - JOUR
T1 - Geographical region and clinical outcomes of patients with primary biliary cholangitis from Western Europe
AU - Murillo Perez, Carla F.
AU - Gerussi, Alessio
AU - Trivedi, Palak J.
AU - Corpechot, Christophe
AU - van der Meer, Adriaan J.
AU - Maria Battezzati, Pier
AU - Lindor, Keith D.
AU - Nevens, Frederik
AU - Kowdley, Kris V.
AU - Bruns, Tony
AU - Cazzagon, Nora
AU - Floreani, Annarosa
AU - Tanaka, Atsushi
AU - Ma, Xiong
AU - Mason, Andrew L.
AU - Gulamhusein, Aliya
AU - Ponsioen, Cyriel Y.
AU - Carbone, Marco
AU - Lleo, Ana
AU - Mayo, Marlyn J.
AU - Dalekos, George N.
AU - Gatselis, Nikolaos K.
AU - Thorburn, Douglas
AU - Verhelst, Xavier
AU - Parés, Albert
AU - Janssen, Harry L. A.
AU - Hirschfield, Gideon M.
AU - Global PBC Study Group
AU - Hansen, Bettina E.
AU - Invernizzi, Pietro
AU - Lammers, Willem J.
N1 - Funding Information: This study was performed on behalf of the Global PBC Study Group and was supported by unrestricted grants from Cymabay Therapeutics Inc., Intercept Pharmaceuticals, and previously from Zambon Nederland BV, and was funded by the Toronto General & Western Hospital Foundation (a not-for-profit organization) in Toronto, Canada, and the Foundation for Liver and Gastrointestinal Research (a not-for-profit organization) in Rotterdam, The Netherlands. The supporting parties had no influence on the study design, data collection and analyses, writing of the manuscript, or on the decision to submit the manuscript for publication. Funding Information: A. Gerussi., M.C., and P.I. were partially supported by the grants from the Italian Ministry of Health (GR-2018-12367794 and PE-2016-02363915). This research was partially supported by the Italian Ministry of University and Research (MIUR) - Department of Excellence project PREMIA (PREcision MedIcine Approach: bringing biomarker research to clinic). A.G., M.C., and P.I. thank AMAF Monza ONLUS and AIRCS for the unrestricted research funding. Publisher Copyright: © 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/1/1
Y1 - 2023/1/1
N2 - Background and aims The are geographic variations in the incidence and prevalence of primary biliary cholangitis (PBC). The aim was to explore whether clinical outcomes of patients within Western Europe differ according to geographical region. Methods Ursodeoxycholic acid-treated patients from European centers from the Global PBC database diagnosed from 1990 onwards were included. Patients with a time lag > 1 year from diagnosis to start of follow-up were excluded. Differences in baseline characteristics were studied according to North/South and East/West, whereas outcomes (transplant-free survival and decompensation) were studied with center latitude and longitude. Cox regression analyses were adjusted for age, sex, diagnosis year, biochemical markers, and cirrhosis as a time-dependent covariate. Results One thousand eight hundred seventy-eight patients were included, and there were no geographical differences in age or sex, with a mean age of 54 years and 89% female patients. Those in North Europe were more often of a moderately advanced/advanced Rotterdam biochemical stage (28.4%) compared with South Europe (20.6%). Additionally, they exhibited higher median alkaline phosphatase (2.0 ×ULN vs. 1.4 ×ULN) and transaminases. In multivariable analysis, there was a significant interaction between center latitude and longitude for decompensation (P < 0.001) and a trend for transplant-free survival, in which the Northwestern area demonstrated an increased risk for poor outcomes as compared to the reference (Paris). Conclusion We describe geographic variations in outcomes for patients across Europe from specialist centers in the Global PBC Study Group. Further study is important to explore the potential individual, environmental, and healthcare-related factors that may be contributors.
AB - Background and aims The are geographic variations in the incidence and prevalence of primary biliary cholangitis (PBC). The aim was to explore whether clinical outcomes of patients within Western Europe differ according to geographical region. Methods Ursodeoxycholic acid-treated patients from European centers from the Global PBC database diagnosed from 1990 onwards were included. Patients with a time lag > 1 year from diagnosis to start of follow-up were excluded. Differences in baseline characteristics were studied according to North/South and East/West, whereas outcomes (transplant-free survival and decompensation) were studied with center latitude and longitude. Cox regression analyses were adjusted for age, sex, diagnosis year, biochemical markers, and cirrhosis as a time-dependent covariate. Results One thousand eight hundred seventy-eight patients were included, and there were no geographical differences in age or sex, with a mean age of 54 years and 89% female patients. Those in North Europe were more often of a moderately advanced/advanced Rotterdam biochemical stage (28.4%) compared with South Europe (20.6%). Additionally, they exhibited higher median alkaline phosphatase (2.0 ×ULN vs. 1.4 ×ULN) and transaminases. In multivariable analysis, there was a significant interaction between center latitude and longitude for decompensation (P < 0.001) and a trend for transplant-free survival, in which the Northwestern area demonstrated an increased risk for poor outcomes as compared to the reference (Paris). Conclusion We describe geographic variations in outcomes for patients across Europe from specialist centers in the Global PBC Study Group. Further study is important to explore the potential individual, environmental, and healthcare-related factors that may be contributors.
KW - environmental factor
KW - geography
KW - risk factor
UR - http://www.scopus.com/inward/record.url?scp=85143367341&partnerID=8YFLogxK
U2 - https://doi.org/10.1097/MEG.0000000000002464
DO - https://doi.org/10.1097/MEG.0000000000002464
M3 - Article
C2 - 36468575
SN - 0954-691X
VL - 35
SP - 112
EP - 119
JO - European Journal of Gastroenterology & Hepatology
JF - European Journal of Gastroenterology & Hepatology
IS - 1
ER -