Preventative therapy in primary biliary cirrhosis.

Because the etiology of PBC is still unknown, therapies remain empirical. Moreover, no contributions on preventative therapy supported by evidence-based medicine have been published to date. However, there are at least two groups of subjects who might benefit from preventative therapy: (1) subjects with normal liver enzymes who are found AMA-positive during autoantibody screening and (2) subjects transplanted for PBC with no histologic or biochemical signs of disease recurrence. The key questions are whether any therapy should be proposed to these subjects, since the natural history of the disease is very long, and what kind of treatment should be prescribed. UDCA is a well-tolerated, definitely "physiologic" treatment, but it is expensive and two recent meta-analyses question its benefit on survival. Current theory considers PBC an autoimmune disease, with a genetic predisposition, possibly triggered by an infectious agent or xenobiotic. If this is so, gene therapies might be the most promising future preventative therapies. For the time being, however, the only practical preventative management is in regards to the complications of PBC, namely osteopenia and portal hypertension.