---
title: >-
  Complication-Free Survival in a Real-World Cohort of PBC Patients: Deep Versus
  Adequate ALP Response to UDCA.
description: >-
  Explore this publication on real-world evidence: Complication-Free Survival in
  a Real-World Cohort of PBC Patients: Deep Versus Adequate ALP Response to
  UDCA..
date: '2024-01-01'
category: Publications
tags:
  - AASLD The Liver Meeting
  - Poster Presentation
  - Approval / Commercialization
  - Care
  - Hepatology
  - PBC
  - Health System Partner
canonical_url: >-
  https://www.pedestalhealth.com/resources/publications/aasld-liver-meeting/complication-free-survival-in-a-real-world-cohort-of-pbc/
source: Pedestal Health
license: © 2026 Pedestal Health. All rights reserved.
slug: complication-free-survival-in-a-real-world-cohort-of-pbc
id: 2MTEdw9kFfJMhSKi8kveF5
contentType: article
---

## Challenge

Current PBC treatment guidelines define response to UDCA as adequate when ALP falls below 1.5–1.67x ULN, but emerging evidence suggested that ALP normalization—a 'deep' response—might confer additional survival benefit. This had not been validated in a large, real-world US cohort with long follow-up.

## Solution

The TARGET-PBC longitudinal cohort was used to compare complication-free survival between patients achieving deep versus adequate ALP responses to UDCA, using Kaplan-Meier, Cox proportional hazards, and restricted mean survival time analyses with advanced fibrosis stratification.

## Impact

Demonstrating that deep ALP response—and deep bilirubin response—are associated with significantly better complication-free survival, particularly in advanced fibrosis patients, provides the real-world foundation for guideline revision and supports the regulatory case for ALP normalization as a treatment target in PBC.

### [Andrea R. Mospan](/people/andrea-mospan/)

![Andrea R. Mospan, PhD, RAC — Profile Photo](https://images.ctfassets.net/h4s3ip99qawo/4w6bkwPHPqrXKYs4tHZPkK/1d21763b54ecc3466764986693b7072f/andrea-mospan.jpg)