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Beyond UDCA: Exploring Second-Line Treatments for Primary Biliary Cholangitis
Published: Mar 23, 2024
While ursodeoxycholic acid (UDCA) is the go-to treatment for primary biliary cholangitis (PBC), it doesn't work for everyone. Discover the promising second-line therapies offering hope to PBC patients.
When UDCA Isn't Enough
About 40% of PBC patients don't respond adequately to UDCA alone. This is where second-line treatments come in. These medications are like reinforcements, helping when the first line of defense isn't strong enough.
Obeticholic Acid: The New Kid on the Block
Obeticholic acid (OCA) is a relatively new treatment approved for PBC. It works by activating a receptor called FXR, which helps regulate bile acid production and flow. Think of OCA as a 'traffic controller' for bile acids in your liver. Studies have shown it can improve liver function tests in patients who don't respond well to UDCA.
Fibrates: Dual-Action Defenders
Fibrates, particularly bezafibrate, have shown promise in treating PBC. These drugs, originally used for lowering cholesterol, also have anti-inflammatory effects in the liver. They're like multi-tool Swiss Army knives, tackling PBC from different angles. Some studies suggest fibrates can improve both liver function and symptoms like itching in PBC patients.
On the Horizon: Emerging Therapies
Research into new PBC treatments is ongoing. Drugs like seladelpar, a PPAR-delta agonist, are showing promising results in clinical trials. Other potential therapies target different aspects of the immune system involved in PBC. It's an exciting time, with researchers working hard to expand treatment options for PBC patients.
Frequently Asked Questions
They're typically used in combination with UDCA.
They can, which is why careful monitoring is important.
It depends on individual factors and response to UDCA.
Availability varies; some may only be accessible through clinical trials.
They aim to slow progression, not reverse existing damage.
The Path Forward
While challenges remain, the expanding array of treatment options offers new hope for PBC patients who don't respond to UDCA alone.
References
- Nevens F, et al. A Placebo-Controlled Trial of Obeticholic Acid in Primary Biliary Cholangitis. N Engl J Med 2016; 375:631.
- Corpechot C, et al. A Placebo-Controlled Trial of Bezafibrate in Primary Biliary Cholangitis. N Engl J Med 2018; 378:2171.
- Hirschfield GM, et al. Efficacy of obeticholic acid in patients with primary biliary cirrhosis and inadequate response to ursodeoxycholic acid. Gastroenterology 2015; 148:751.
- Bowlus CL, et al. A phase II, randomized, open-label, 52-week study of seladelpar in patients with primary biliary cholangitis. J Hepatol 2022; 77:353.
This article has been reviewed for accuracy by one of the licensed medical doctors working for Doctronic. Always discuss health information with your healthcare provider.
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