P46 Ethnic variation in disease progression and treatment in primary biliary cholangitis: results from a tertiary hepatology centre

<h3>Introduction</h3> Evidence suggests ethnic variation in primary biliary cholangitis (PBC) disease progression, but existing literature focuses on North American populations, with limited data from the UK.^{1 2} We aimed to compare PBC disease progression and treatment response across ethnic groups at a UK tertiary hepatology centre, which serves an ethnically diverse London borough³. <h3>Methods</h3> We conducted a single-centre cross-sectional study of PBC outpatients at The Royal London Hospital hub centre. Data were collected from clinical records, including demographics, markers of disease progression, and treatment response rates. Comparative subgroup analysis was undertaken across ethnic groups. <h3>Results</h3> 116 patients were identified, of which 20 were excluded due to unavailability of ethnicity data. 96 patients were included. Findings are summarised in table 1. Results are reported as mean ± standard deviation, or percentage of patients. Statistical significance was not reached in subgroup analysis due to limited sample sizes. 73% of included patients were Caucasian, 20% Asian, and 7% Black. All groups showed comparable age at diagnosis. ALP at diagnosis was noted to be higher in Caucasian patients (334 ± 277 U/L) than Asian (263 ± 204 U/L) and Black (250 ± 183 U/L) patients. Recent LSM readings appeared comparable among Caucasian (9.9 ± 10.6 kPa) and Asian (10.2 ± 11.8 kPa ) patients; there was insufficient LSM data among Black patients for analysis (n=3). First-line treatment rates with ursodeoxycholic acid (UDCA) were comparable across groups. Progression to SLT was more commonly seen in Black (43%) and Caucasian (39%) patients than in Asian patients (26%). Obeticholic acid was more widely prescribed than bezafibrate in all groups. Asian patients were observed to have a higher response rate to SLT (80%) than Caucasian (63%) and Black (67%) patients. <h3>Discussion</h3> We observed variability in PBC disease progression and treatment among ethnic groups. In particular, Caucasian patients tended to present with higher ALP at diagnosis, and Asian patients were observed to have lower SLT initiation rates and higher response rates. In contrast to existing literature, Asian patients represented the largest ethnic minority group in our cohort, reflecting UK demographic data; disease characteristics in this group are not well studied⁴. If validated in multi-centre cohorts on a national scale, these trends could inform tailored treatment approaches in an increasingly diverse UK PBC population. <h3>References</h3> Trivella J, John BV, Levy C. Primary biliary cholangitis: epidemiology, prognosis, and treatment. <i>Hepatology Communications</i> 2023;7(6):e0179. Peters MG, Di Bisceglie AM, Kowdley KV, <i>et al</i>. Differences between Caucasian, African American, and Hispanic patients with primary biliary cirrhosis in the United States. <i>Hepatology</i> 2007;46(3):769–775. Office for National Statistics (2023). <i>How life has changed in Tower Hamlets: Census 2021</i>. www.ons.gov.uk/visualisations/censusareachanges/E09000030. Office for National Statistics (2022). <i>Ethnic group, England and Wales – Office for National Statistics</i>. www.ons.gov.uk/peoplepopulationandcommunity/culturalidentity/ethnicity/bulletins/ethnicgroupenglandandwales/census2021.