Approach to slowing disease progression for patients with primary biliary cholangitis

HAV: hepatitis A virus; HBV: hepatitis B virus; UDCA: ursodeoxycholic acid; OCA: obeticholic acid; ULN: upper limit of normal; ALT: alanine aminotransferase; AST: aspartate aminotransferase.
* Liver biochemical tests (ALT, AST, alkaline phosphatase, and total bilirubin) and platelet count are obtained every 3 to 6 months to assess disease activity and monitor response to therapy.
¶ The efficacy of obeticholic acid and bezafibrate appear comparable in this setting, and therapy selection is based on drug availability, clinician preference, and disease severity. Obeticholic acid is not widely available outside of North America, and it is contraindicated in patients with decompensated cirrhosis (Child-Pugh class B or C; refer to UpToDate calculator for Child-Pugh score for severity of liver disease), a prior decompensation event (gastroesophageal varices, encephalopathy), or compensated cirrhosis with portal hypertension. 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.