Should something be done with a “moderately high” ALP?

[Gaspereaux]

Good moring! I had my bloods drawn last week and both ALT and AST went back to normal. My GGT came down but not normal, and ALP stayed the same as three months ago at 177 It was previously 385. (here, the ULN is 122). I have been on Urso for nine months, but only on the optimal dose for four months.

My GGT lowered from 569 to 225 as well.

My question is, if, in three months time, my levels remain the same with an ALP of 1.46 x the upper limit of normal, does on jut remain on URSO alone or is it normal to take a second line therapy to attempt to reach the absolute normal?

Thanks everyone!

[DonnaBoll Administrator]

Great question! I'm glad you mentioned that you have only been on the optimum dose of Urso for 4 months. Being on the right dose is crucial to give the Urso the chance to be the most effective. I can assure you that many of us with PBC never have their liver enzymes in the 'normal' range. We do have a big improvement though from where we started. You mentioned that your alk phos started at 385 but now 177. That is a big improvement. I know it's hard to be patient but give the dose of Urso more time, I think. Some experts are happy with an all phos below 200. It certainly sounds like your numbers are going in the right direction. Personally, I would continue to have my labs drawn every 3-6 months for awhile and see what happens with this Urso dose. I know most of us feel like we need to make changes quickly, but remember that PBC is a very slow progressive disease. Have you had this conversation with your hepatologist?