Opinion
Video
Second-Line Treatments and Management of Symptoms in PBC
Key Takeaways
- OCA is a second-line therapy for PBC, activating the farnesoid X receptor to reduce bile acid synthesis.
- Long-term OCA use can cause pruritus and fatigue, requiring effective symptom management strategies.
The panel of experts cover second-line treatment options for primary biliary cholangitis (PBC), focusing on the use of obeticholic acid (OCA), its mechanism of action, management of adverse effects like pruritus and fatigue, the role of off-label fibrates, and strategies for assessing and adjusting therapy based on patient response and adverse effects.
Video content above is prompted by the following:
- There are several second-line therapy options, including the first approved option, OCA. When do you use OCA, and when do you evaluate if it successfully meets treatment goals?
- Could you briefly explain its mechanism?
- Long-term treatment with OCA is associated with pruritus (77% of patients) and fatigue (33% of patients) (Trauner, 2019), which are also symptoms of PBC. What strategies do you use to manage these symptoms in general?
- How do you counsel patients who may consider starting OCA and are affected by pruritus prior to therapy
- The off-label use of fibrates has been another treatment option for PBC. When and how do you use fibrates for treating PBC? What are some challenges and adverse effects of fibrates?
- How do you assess the effectiveness of these therapies in managing the disease? Please comment on biochemical response, pruritus, potential adverse effects, etc.
- What are the key indicators that suggest a need for a change in treatment strategy?
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