Old and new treatments for primary biliary cholangitis

David Chascsa, Elizabeth J. Carey, Keith D. Lindor

Research output: Contribution to journalArticle

19 Scopus citations

Abstract

Primary biliary cholangitis (formerly primary biliary cirrhosis) is a rare progressive cholestatic liver disease, whose hallmark features include a persistently elevated alkaline phosphatase level, presence of anti-mitochondrial antibodies and characteristic histology. Since 1998, ursodeoxycholic acid (UDCA), a bile acid, has been the only available therapeutic agent. Primary biliary cholangitis is associated with the development of end-stage liver disease, increased morbidity and mortality. UDCA has been shown to improve serum biochemistries, histology and delay the need for liver transplantation. The clinical issue is that approximately 25%-40% of patients do not respond to this standard therapy. In recent years, many trials have investigated alternative and adjunctive treatments, leading to the recent approval of obeticholic acid, an analogue of chenodeoxycholic acid, which has shown significant and sustained reductions in alkaline phosphatase levels in combination with UDCA. Obeticholic acid has rapidly been embraced as a new agent to improve the biochemical profile in refractory patients, in addition to being approved for use as monotherapy in patients who cannot tolerate UDCA. There are several other studies and targets which are being investigated. This review is intended to highlight the benefits of UDCA, educate the reader on the newly available obeticholic acid, and to summarize the many ongoing trials and therapeutic targets being investigated in attempts to control and cure primary biliary cholangitis.

Original languageEnglish (US)
Pages (from-to)490-499
Number of pages10
JournalLiver International
Volume37
Issue number4
DOIs
StatePublished - Apr 1 2017

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Keywords

  • obeticholic acid
  • primary biliary cholangitis
  • treatment
  • ursodeoxycholic acid

ASJC Scopus subject areas

  • Hepatology

Cite this

Chascsa, D., Carey, E. J., & Lindor, K. D. (2017). Old and new treatments for primary biliary cholangitis. Liver International, 37(4), 490-499. https://doi.org/10.1111/liv.13294