Approach to slowing disease progression for patients with primary biliary cholangitis

ALT: alanine aminotransferase; AST: aspartate aminotransferase; HAV: hepatitis A virus; HBV: hepatitis B virus; PPAR: peroxisome proliferator-activated receptor; UDCA: ursodeoxycholic acid; ULN: upper limit of normal.

* Liver biochemical tests (ALT, AST, alkaline phosphatase, and total bilirubin) and platelet count are obtained to assess disease activity and monitor response to therapy.

¶ PPAR agonists include elafibranor, seladelpar, and fibrates (eg, bezafibrate). The efficacy of obeticholic acid and PPAR agonists appear comparable in this setting, and therapy selection is based on drug availability, patient preference, clinician preference, and cost. We do not use obeticholic acid or PPAR agonists in patients with decompensated cirrhosis (Child-Pugh class B or C; refer to UpToDate calculator for Child-Pugh score for severity of liver disease). Obeticholic acid, elafibranor, and seladelpar are not widely available outside of North America. Bezafibrate is not available in the United States, while use of other fibrates (eg, fenofibrate) is off-label.

Δ Refer to UpToDate content on liver transplantation for patients with primary biliary cholangitis.