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Review
. 2021 Mar 1;37(2):99-104.
doi: 10.1097/MOG.0000000000000708.

Primary biliary cholangitis: treatment

Nora Cazzagon  1 , Annarosa Floreani  2   3
Affiliations
Review

Primary biliary cholangitis: treatment

Nora Cazzagon et al. Curr Opin Gastroenterol. .

Abstract

Purpose of review: To discuss the most recent data regarding treatment of patients with primary biliary cholangitis (PBC) with inadequate response to ursodeoxycholic acid (UDCA).

Recent findings: Patients with PBC at high-risk of progressive disease are younger, have advanced fibrosis and showed inadequate response to UDCA after 12 months of treatment. These patients need a second-line treatment in addition to UDCA. The goal of therapy should be the normalization of ALP and bilirubin below 0.6 the upper limit of normal. Obeticholic acid (OCA) has proven to be effective in improving surrogate markers of prognosis in PBC, also in real-life cohort. Pruritus is the most frequent adverse event during treatment with OCA. Bezafibrate is another option in patients with inadequate response to UDCA as it was proven to improve surrogate endpoints, pruritus and even, clinical outcome compared with UDCA monotherapy. Finally, budesonide may be considered in patients with marked portal inflammation. Triple therapy with UDCA, OCA and bezafibrate may be considered in patients showing inadequate response to dual therapy.

Summary: Patients with PBC need to be evaluated at baseline, and on-treatment, for the risk of progressive disease and eventually treated with second-line therapies in addition to UDCA.

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References

    1. Kaplan MM, Gershwin ME. Primary biliary cirrhosis. N Engl J Med 2005; 353:1261–1273.
    1. Carey EJ, Ali AH, Lindor KD. Primary biliary cirrhosis. Lancet 2015; 386:1565–1575.
    1. European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu, European Association for the Study of the Liver. EASL Clinical Practice Guidelines: the diagnosis and management of patients with primary biliary cholangitis. J Hepatol 2017; 67:145–172.
    1. Corpechot C, Chazouillères O, Belnou P, et al. Global PBC Study Group. Long-term impact of preventive UDCA therapy after transplantation for primary biliary cholangitis. J Hepatol 2020; 73:559–565.
    1. Lindor KD, Bowlus CL, Boyer J, et al. Primary biliary cholangitis: 2018 practice guidance from the American Association for the Study of Liver Diseases. Hepatology 2018; 69:394–419.