Method: We collected datafrom 182 adult patients who underwent liver biopsy (LB) for PBC at diagnosis in five Italian livercenters from Jan 2006 through Aug 2019. TE examinations within 3 months from LB were included. LB were scored centrally by two expert patholo- gists, blinded to clinical data and disease stage, according to Ludwig staging system. In all patients Fibrosis-4 (FIB-4) and aspartate aminotransferase [AST]/platelet ratio (APRI) score have been calcu- lated. Diagnostic accuracy of LSM, FIB-4 and APRI score was estimated using the area under the receiver operating characteristic curves (AUROCs) for fibrosis. The effects of liver biochemistry and histo- logical parameters were appraised using multivariable logistic model. Results: 123 PBC patients had adequate LB (≥9 portal tracts) and valid LSM values. According to histological assessment, Ludwig stage distribution was as follows: stage I = 38 (30.9%), stage II = 46(37.4%), stage III = 27 (21.9%), stage IV = 12 (9.8%). TE identified patients with Ludwig stage III/IV with an AUROC of 0.83 (95% confidence interval [CI] (0.74, 0.90)) (Figure). The optimal threshold was identified at 6.75kPa (CI (6.55, 7.50)), with 85% of sensitivity, 75% of specificity, 78% of accuracy and 6 false negative. TE was superior to APRI and FIB- 4 having AUROC of 0.638 (CI = (0.535, 0.740)) and 0.641 (CI = (0.516, 0.766)), respectively. At multivariable analysis only LSM was associated with liver fibrosis and no significant effect of biochemical measures and steatosis was found. Conclusion: LSM is accurate to predict moderate to severe liver fibrosis at diagnosis in PBC naïve patients using a threshold of 6.75 kPa with an AUROC of 0.83. TE outperformed FIB-4 and APRI score and is not confounded by liver biochemistry and steatosis. These data can inform strategies for patient surveillance and trial design in PBC. FRI159 Ciprofibrate: a new option of fibrate for primary biliary cholangitis with incomplete response to ursodeoxycholic acid Laura Guedes 1 , Michele Harriz Braga 1 , Bruna Damasio Moutinho 1 , Flair Jose Carrilho 1 , Eduardo Luiz Rachid Cançado 2 . 1 Clinical Hospital, Gastroenterology and Hepatology, Sao Paulo, Brazil; 2 Clinical Hospital, Gastroenterology and Hepatology, São Paulo, Brazil Email: lauvguedes@gmail.com Background and Aims: Bezafibrate and fenofibrate both have substantial evidence of anticholestatic properties in patients with primary biliary cholangitis (PBC). Ciprofibrate, one of the most potent peroxisome proliferators, had never been studied in this scenario. Our goal was to describe an experience with ciprofibrate in PBC with incomplete response to UDCA. Method: A retrospective study was conducted with 40 patients (38 women) with cholestasis and anti-mitochondrial antibody reactivity with incomplete UDCA response (Paris II criteria). Ciprofibrate was combined at a daily dose of 100mg between 2013 and 2017, and patients were followed until May 2019. Blood samples were obtained at diagnosis, after 12 months of UDCA use and at 3, 6, and 12 months after combination with ciprofibrate. We compared laboratory tests by paired two-tailed T-test, and p < 0.05 was considered significant. Results: Mean age at diagnosis was 44.8 years; 3 patients (9.4%) had cirrhosis and 23 (57.5%) had moderate to severe pruritus. UDCA reduced the levels of alkaline phosphatase (ALP), gamma glutamyl transferase (GGT), aspartate aminotransferase (AST), alanine amino- transferase (ALT), total bilirubin (TB) and reduced partially pruritus in 23 patients (74.2%), and completely in 8 (25.8%). Association with ciprofibrate reduced ALP and GGTat 12 months, 83.9% had complete response and afteroneyear 37.5% of patients had ALP, GGT, AST, ALT, TB, albumin and prothrombin index normalized. It also fully eliminated itching in 81% of patients who still had itching under UDCA. The ciprofibrate dose was reduced to 100 mg every other day in 14 patients (35%) after an average of 12 months and was withdrawn in 14 (35%) after an average of 13 months. The main side effects were myalgia, hepatitis, dyspepsia, increased creatinine, creatine phos- phokinase, TB levels. Among non-cirrhotic patients, 7 (17.5%) evolved to cirrhosis, 4 of them had withdrawn fibrate. One patient died 18 months after fibrate withdrawal and another one progressed to liver transplantation due to refractory itching despite the use of UDCA and ciprofibrate for 24 months. Conclusion: Ciprofibrate appears to be as effective as other fibrates as adjunctive treatment of PBC. However, there were a large number of side effects. Randomized controlled trials are needed to compare the efficacy and safety of different fibrates. FRI160 Utility of thiopurine metabolite testing in autoimmune hepatitis: defining an optimal therapeutic range for disease management and measurement may avert relapse and adverse drug reactions Lena Susanna Candels 1 , Mussarat Rahim 2 , Andrew Yeoman 2 , Guan Wee Wong 2 , Michael Heneghan 2 . 1 Institute of Liver Studies, King’s College Hospital, London, United Kingdom; 2 Institute of Liver Studies, King’s College Hospital, London, United Kingdom Email: michael.heneghan@nhs.net Background and Aims: Patients with autoimmune hepatitis (AIH) receive maintenance therapy with thiopurines, e.g. azathioprine (AZA) at 1–2 mg/kg/day. Genetic polymorphisms in the metabolism of AZA lead to variation in levels of metabolites, thioguanine nucleotide (TGN) and 6-methylmercaptopurine (6-MMP) which is associated with adverse drug reactions (ADR). For inflammatory bowel disease, a therapeutic range of TGN 235–450 pmol/8 × 10 8 erythrocytes has been identified to optimize effectiveness. We aim to elucidate the benefits of metabolite monitoring in patients with AIH. Method: 109 patients with AIH were identified as having thiopurine metabolite levels between 1999–2019. In addition, 105 AIH patients on a weight-based dose of thiopurine, who had never had metabolite levels, were also identified. Charts were reviewed retrospectively. Chi squared test was used for statistical analysis. Results: In those that had TGN monitoring, 73% (80/109) were female and the mean age at presentation was 35 yrs (range 4–82). In those that had no TGN monitoring, 74% (78/105) were female and the mean age at presentation was 37 yrs (range 7–70). In the TGN and non-TGN groups, 73% and 81% had type 1 AIH, 6% and 5% had type 2 AIH and 21% and 14% had auto-antibody negative AIH (respectively). Patients with metabolite measurements had less loss of remission compared to those without metabolite levels (13% vs. 24%, p = 0.045). TGN levels within the therapeutic range predicted more stable POSTER PRESENTATIONS S479 Journal of Hepatology 2020 vol. 73 | S401–S652