Role of Ursodeoxycholic Acid (Udiliv) in Managing Transaminitis
Ursodeoxycholic acid (UDCA) is not recommended as a specific treatment for transaminitis unless it is associated with cholestatic liver diseases such as primary biliary cirrhosis (PBC) or intrahepatic cholestasis of pregnancy. 1
Mechanism of Action of UDCA
UDCA works through several mechanisms that can be beneficial in cholestatic conditions:
- Protection of injured cholangiocytes against toxic effects of bile acids 2
- Stimulation of impaired biliary secretion 2
- Suppression of hepatic synthesis and secretion of cholesterol 3
- Inhibition of intestinal absorption of cholesterol 3
- Anti-apoptotic effects on hepatocytes 2, 4
- Immunomodulatory properties that may reduce immune-mediated liver damage 5, 6
Indications for UDCA in Liver Diseases
Recommended Uses:
- Primary Biliary Cirrhosis (PBC): UDCA at 13-15 mg/kg/day is the first-line treatment for PBC, with evidence showing it delays histological progression and improves biochemical markers 1, 7
- Intrahepatic Cholestasis of Pregnancy: UDCA should be offered to women with serum bile acid concentrations >40 μmol/L to reduce the risk of spontaneous preterm birth 1
Not Recommended For:
- Non-alcoholic Fatty Liver Disease (NAFLD) or Non-alcoholic Steatohepatitis (NASH): UDCA is explicitly not recommended for the treatment of NAFLD or NASH 1
- Primary Sclerosing Cholangitis (PSC): The British Society of Gastroenterology strongly recommends against routine use of UDCA for newly diagnosed PSC 1, 8
- Transaminitis without cholestatic features: There is no evidence supporting UDCA use in isolated transaminitis 1, 6
Dosing Considerations
- For PBC: 13-15 mg/kg/day is the recommended dose 1, 7
- For intrahepatic cholestasis of pregnancy: Similar dosing is typically used 1
- High-dose UDCA (28-30 mg/kg/day) has been associated with increased adverse events in PSC and should be avoided 1, 8
Monitoring During Treatment
- Regular monitoring of liver biochemistry is essential to assess response 7
- In PBC, biochemical response should be assessed after 12 months of treatment 7
- For intrahepatic cholestasis of pregnancy, alterations in total serum bile acid concentrations should be monitored after UDCA treatment has been commenced 1
Potential Risks and Contraindications
- UDCA is generally contraindicated in complete biliary obstruction, although one case report suggests moderate doses might be protective 9
- High-dose UDCA (28-30 mg/kg/day) has been associated with worse outcomes in PSC 1, 8
- UDCA is generally well-tolerated with minimal side effects at standard doses 3, 5
Conclusion for Clinical Practice
For transaminitis management:
- First, determine the underlying cause of transaminitis through appropriate diagnostic workup
- If transaminitis is associated with cholestatic features in PBC, UDCA is the treatment of choice 1, 7
- If transaminitis is associated with intrahepatic cholestasis of pregnancy, UDCA should be considered 1
- For transaminitis in NAFLD/NASH, UDCA should not be used 1
- For transaminitis in PSC, UDCA is not recommended as routine treatment 1, 8
- For isolated transaminitis without cholestatic features, there is no evidence supporting UDCA use 1, 6