American Board of Internal Medicine (ABIM) Certification Practice Exam

Which statement is true regarding treatment response to ursodiol in patients with primary biliary cholangitis?

1. Most patients have a strong treatment response

2. Nonresponse is more common in older patients

3. 40-50% continue to have elevated serum ALP levels

4. Ursodiol is ineffective in treating PBC

The correct answer is: 40-50% continue to have elevated serum ALP levels

The statement that 40-50% of patients with primary biliary cholangitis (PBC) continue to have elevated serum alkaline phosphatase (ALP) levels despite treatment with ursodiol is accurate. Ursodiol is a medication that is commonly prescribed for PBC to help improve liver function and reduce levels of serum ALP, which is a marker of cholestasis. However, clinical studies have shown that even with treatment, approximately one-third to one-half of patients may not achieve normal serum ALP levels. This persistent elevation can indicate an inadequate response to therapy or a more progressive form of the disease. In the context of treatment for PBC, a significant proportion of patients experience an incomplete response to ursodiol, making this statement a critical point of understanding regarding the disease's management and the limitations of the treatment. It highlights the need for ongoing monitoring and consideration of alternative therapies for those who do not achieve the desired biochemical response.