ALP and when to add 2nd line therapy

[Heaslea]

I was diagnosed Feb. 2022 ALP was 307. Started URSO right away. ALP went down quickly - In July 2022 it was 107 but October 2022 was 119 and April 2023 was 120. So my specialist wanted to add ocaliva. I convinced him to give it another 6 months before adding anything and he agreed. So I am praying my numbers will lower without another med. Then I saw many take fenofibrate instead so I was curious as my doc did not mention it as an option.

And if you are still reading one question is - I don't fully understand the math - it mentions in David Jones definitive guide that you add the 2nd line drug when ALP is 1.67 times the upper limit of normal. So in my case - in lab used - normal is considered 35 to 104. I am not good at math so with my last result being 120 is that outside the 1.67? Trying to determine if the 2nd drug is necessary. Thank-you.

[Candy12]

The Math for 1.67 of the upper limit of normal would be. Your labs upper limit (in your case 104) multiply that by 1.67. It’s not taken from your actual level of ALP. Bear in mind though, when making a decision on second line medication. The new way of thinking ( from listening to prof Jones on the Q&A sessions) seems to be to get your bloods as close to normal as possible. You can listen to the the sessions on the foundation Facebook page. Bettter still email in your your question and listen to the reply.

I take Bezafibrate now and my Alp is at 80, after about 10 years of it fluctuating around 180/204 the highest was 268 that’s when I started the fibrate over 4 years ago now. Hope that helps a little.

[Heaslea in reply to Candy12]

Thanks for this - I will see if I can find the Q and As you referred to - appreciate.