Epidemiology and treatment practices of chronic cholestatic liver disease in India: a physician survey-based study

Background: Chronic cholestatic liver disease (CCLD) constitutes an intricate array of liver diseases in India. A physician-based survey was conducted to understand the prevalence, current treatment approaches, and gaps in the management of CCLD in India.
Methods: A total of 215 physicians participated to complete a questionnaire comprising 35 questions related to the prevalence and current treatment of CCLD and assess gaps in its management.
Results: Most physicians (53.5%) reported liver disorders with cholestasis to be prevalent in 10-20% of patients, while 34.9% reported their prevalence in 21-30% of patients. Alcoholic liver disease with cholestasis (CCLD [ALD]) was reported in 10-20% of patients and 21-30% of patients by 33.5% and 37.2% of physicians, respectively. Drug-induced liver disease with cholestasis (CCLD [DILI]) was reported to be present in 5-10% of patients by 34.9% of physicians. Ursodeoxycholic acid (UDCA) was found to be used by 60% physicians in >50% of patients with CCLD (ALD), commonly for a period of 4-12 weeks (48.4% physicians), while it was used for 12-24 weeks by 38.1% physicians in CCLD (DILI); for both conditions, the preferred dose was 10-15 mg/kg body weight. UDCA was reported to have good tolerability and efficacy by most physicians for both conditions.
Conclusions: In light of scarce data on CCLD prevalence and management approaches in India, the present survey findings provide useful insights on its prevalence in India and support the use of UDCA therapy for the management of its symptoms.