S58 Fibrates as an Adjunct Therapy in Primary Biliary Cholangitis Is Associated With Lower Hospitalization and Healthcare Utilization: A Propensity-Matched Analysis

Introduction: Fibrates is considered a second line agent for primary biliary cholangitis (PBC) and improves biochemical responses in PBC patients not responding to ursodeoxycholic acid (UDCA). It is unclear whether these biochemical response from fibrates results in improvement in clinical outcomes in the real world. We therefore compared liver-related complications, extrahepatic sequelae, and healthcare utilization in propensity-matched cohorts of PBC patients treated with ursodeoxycholic acid alone or with UDCA plus a fibrate in a large research database. Methods: The TriNetX Research Network (104 United States healthcare organizations; study window 2005 to 2024) was queried for adults carrying diagnosis of PBC who were prescribed UDCA. Cohort A was also prescribed additional fibrate (fenofibrate, gemfibrozil, bezafibrate, or ciprofibrate); Cohort B was on UDCA monotherapy. One-to-one nearest-neighbor propensity-score matching balanced demographics, comorbidities, and baseline laboratories, yielding 1,580 patients per group. Outcomes accruing from day +1 through 5 years were analyzed as hazard ratios (HR). Results: Over 5 years, fibrate patients were less likely to develop spontaneous bacterial peritonitis (2.0% vs 1.1%, HR 0.52, 0.29-0.92), and had fewer incidences of all-cause hospitalizations (26.7% vs 21.8%, HR 0.75, 0.65-0.86). The incidence of cirrhosis, ascites, hepatic encephalopathy, variceal bleeding, and hepatocellular carcinoma did not differ significantly. Our analyses showed fewer new diagnoses of fatigue with fibrates (9.0% vs 10.6%; HR 0.77, 0.60-0.99), but the 2 groups did not differ significantly in the incidence of osteoporosis without fracture (8.3% vs 10.2%; HR 0.737, 0.575-0.945). Last, 5-year all-cause mortality was identical in both cohorts (9.3% vs 9.3%; HR 0.919, 0.731-1.155). Conclusion: In the large real-world analysis to date, adding a fibrate to UDCA was associated with a 44% relative reduction in spontaneous bacterial peritonitis and an 18% reduction in hospitalizations, without additional hepatic or extrahepatic adverse events. These data suggest that fibrates is an effective adjunct therapy for PBC patients on UDCA. Prospective trials are warranted to validate these findings and define optimal candidate selection.