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Jybay

06 mai 2025 •18:43

PBC Questions and Cases: The Place of Newer Therapies


Clinical Care Options
4 354 abonnés


6 mai 2025
Key Takeaways

Considerations for starting second-line therapy for PBC should focus on ALP assessment at 6 or 12 months after treatment with UDCA for high-risk and low-risk groups, respectively.
Newer PPAR agonists show promising effects on lowering ALP as second-line therapies, and we look forward to longer-term data on liver-related outcomes.

Contenu de l’article
Newer therapies for treatment of primary biliary cholangitis (PBC), such as elafibranor and seladelpar, have the potential to improve not just disease progression, but also extrahepatic symptoms. To understand more about the current treatment landscape of PBC, including the place of these newer therapies, here are my answers to learner questions from a recent educational activity.

Do you ever use initial combination therapy for people with PBC who have risk factors for progression?

The second-line therapies—obeticholic acid, elafibranor, and seladelpar—are indicated for persons who do not have a response to or are intolerant to first-line ursodeoxycholic acid (UDCA), but researchers are still exploring early initiation of combination therapy with UDCA and these second-line agents.

Until we see enough safety and efficacy data from these studies, I would adhere to guideline-recommended treatments. The current treatment guidelines are to start with UDCA monotherapy, then assess the biochemical response at 12 months, or for those at higher risk, at 6 months. Then, a determination can be made as to whether the patient might require combination treatment with a second-line therapy.

How long should you wait to see an effect with UDCA before moving on to second-line combination therapy? What threshold do you use?

For people with a low risk of progression, such as those with a liver stiffness of