Expert Perspectives on the Use of Ursodeoxycholic Acid in Managing Liver Disorders in Indian Settings

Abstract

Background: Ursodeoxycholic acid (UDCA), a hydrophilic bile acid, has established therapeutic benefits in several liver disorders. It is the first-line treatment for primary biliary cholangitis (PBC), where it improves liver enzyme levels, slows disease progression, and enhances survival. It is also useful in cholesterol gallstone dissolution and has demonstrated benefits in MAFLD by improving hepatic steatosis and normalizing liver enzymes Objective: The present study gathers expert opinion on the use of ursodeoxycholic acid (UDCA) in the management of liver disorders in Indian settings. Methodology: The cross-sectional study used a 22-item, multiple-response questionnaire to capture expert insights on diagnosis, clinical spectrum, therapeutic indications, dosing preferences, and experiences with UDCA. The study included specialists experienced in managing liver diseases in routine Indian settings. Data were analysed using descriptive statistics. Results: The study comprised 519 clinicians, with approximately 53% identifying metabolic-dysfunction-associated fatty liver disease (MAFLD) as the most common liver condition. According to 79% of participants, the advantages of UDCA in managing liver diseases include inhibition of bile acid synthesis, reduction of cholesterol absorption in the intestines, protection of cholangiocytes from the toxic effects of bile acids, and stimulation of hepatocellular regeneration. As reported by 77% of clinicians, the preferred UDCA dose for patients with MAFLD was 300 mg twice daily. UDCA is considered a preferred treatment by 70% of experts for conditions such as hepatic encephalopathy, primary biliary cholangitis (PBC), hepatocellular carcinoma, alcoholic liver disease, MAFLD, and NASH. About 46% of respondents found UDCA very effective in treating primary cirrhosis. Most clinicians (81.7%) indicated that UDCA therapy improves liver enzyme levels, slows disease progression, and enhances liver histology in patients with chronic cholestatic liver disease, particularly PBC. Conclusion: The study demonstrates that Indian clinicians widely recognize UDCA as a preferred therapy for diverse liver disorders, especially MAFLD and chronic cholestatic conditions such as PBC. UDCA 300 mg twice daily is the preferred regimen, with strong consensus on its efficacy in improving liver enzymes, slowing disease progression, and enhancing liver histology in clinical practice.