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Spotlight -

This Year In Medicine 2025

Opinion|Videos|November 27, 2024

Second-Line Treatments and Management of Symptoms in PBC

Author(s)Nancy Reau, MD, John Vierling, MD, FACP, FAASLD, AGAF, Aparna Goel, MD

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.
Fibrates are an off-label alternative for PBC, with challenges including potential adverse effects.
Effectiveness of therapies is assessed through biochemical response and symptom management.
Treatment strategy changes are indicated by inadequate response or adverse effects.

SHOW MORE

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.

Episodes in this series

4 experts are featured in this series.

EP. 1 Pathophysiology of PBC

4 experts are featured in this series.

EP. 2 Presentation and Diagnosis of PBC

4 experts are featured in this series.

EP. 3 Differential Diagnosis of PBC

4 experts are featured in this series.

EP. 4 Disease Progression and Extrahepatic Manifestations of PBC

4 experts are featured in this series.

EP. 5 Second-Line Treatments and Management of Symptoms in PBC

4 experts are featured in this series.

EP. 6 Treatment Goals and First-Line Therapy in PBC

4 experts are featured in this series.

EP. 7 Seladelpar for Treatment of PBC

4 experts are featured in this series.

EP. 8 PPAR Agonists for Treatment of PBC

4 experts are featured in this series.

EP. 9 Elafibranor and Choosing Amongst PPAR Agonists in PBC

4 experts are featured in this series.

EP. 10 Pruritus Control With PPAR Agonists in PBC

4 experts are featured in this series.

EP. 11 Integration of PPAR Agonists in Treatment Landscape of PBC

4 experts are featured in this series.

EP. 12 Treatment Response to PPAR Agonists and Other Therapies in PBC

4 experts are featured in this series.

EP. 13 Thoughts on the Current State of PBC Management

4 experts are featured in this series.

EP. 14 Outcomes and Adoption of PPAR Agonists in PBC

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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