Progress in PBC, PSC: Key Updates in Cholestatic Liver Disease Care With Ann Moore, NP

Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are driving new momentum in hepatology, with recent therapeutic breakthroughs and updated guidance reshaping care for patients with cholestatic liver disease.

At the 2025 Gastroenterology & Hepatology Advanced Practice Providers (GHAPP) conference, Ann Moore, NP, a nurse practitioner at Arizona Liver Health, broke down some of these advances and their impact on the field of hepatology. While she says some years can be “a little bit boring,” this was not the case in 2024, specifically citing the US Food and Drug Administration (FDA) approvals of 2 new second-line therapies for PBC in the form of elebibranor (Iqirvo) and seladelpar (Livdelzi).

Moore explains how these approvals greatly expanded the PBC treatment armamentarium, which previously only consisted of first-line ursodeoxycholic acid (UDCA) and second-line obeticholic acid. While UDCA remains the sole first-line standard, second-line options are essential for the 40% of patients who do not respond to or cannot tolerate it.

“2024 brought the FDA approvals, but 2025 brought real world experience using these new medications,” Moore said, describing lessons learned regarding safety, tolerability and access. “I think overall, in my clinical experience, it was a super successful year and fun to try new therapies and see how they work.”

Specifically, Moore cites the importance of having therapies that have the potential to improve not only biochemical measures of disease, but also symptoms like itch and fatigue. She says many providers are focused solely on normalizing alkaline phosphatase and maintaining normal bilirubin, forgetting about the patient attached to the disease and the importance of treating the symptoms they find most burdensome.

“We have great second line therapies and we need to think about them early, we need to monitor and treat early and individualize patient care, because now we can, because we have options,” Moore said.

For PSC, she says instead of excitement, there is hope. While no therapies have yet been approved, phase 3 data for NorUDCA and updated guidelines from the American Association for the Study of Liver Diseases on diagnosis and cancer surveillance offer cautious optimism.

“I think overall, [there’s been a] great impact for our patients with cholestatic liver disease,” Moore said.

References

1. Brooks A. FDA Grants Accelerated Approval to Elafibranor (Iqirvo) for PBC. HCPLive. June 10, 2024. Accessed September 8, 2025. https://www.hcplive.com/view/fda-grants-accelerated-approval-to-elafibranor-iqirvo-for-pbc

2. Brooks A. FDA Grants Accelerated Approval to Seladelpar (Livdelzi) for Primary Biliary Cholangitis. HCPLive. August 14, 2024. Accessed September 8, 2025. https://www.hcplive.com/view/fda-grants-accelerated-approval-to-seladelpar-livdelzi-for-primary-biliary-cholangitis

3. Bowlus CL, Arrivé L, Bergquist A, et al. AASLD practice guidance on primary sclerosing cholangitis and cholangiocarcinoma. Hepatology. doi:10.1002/hep.32771