Taha Qazi, MD: Fenofibrate As First-Line Therapy in Primary Biliary Cholangitis

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Qazi discusses a review of the use of fenofibrate as a first-line therapy in treatment-naive patients with PBC and its implications for biochemical response.

The fifth issue of Qazi Corner, a collaborative quarterly newsletter on gastroenterology research, news, and trends between HCPLive and editor-in-chief Taha Qazi, MD, featured a review of a randomized controlled trial examining the effectiveness of fenofibrate in treatment-naive patients with primary biliary cholangitis (PBC).

Although ursodiol remains standard first-line therapy, biochemical non-response remains an issue for many patients. The American Association for the Study of Liver Diseases conditionally recommends fibrates as an off-label, adjunctive second-line treatment in these patients, but findings from this study shine light on their potential role as first-line therapy for PBC.

Speaking on the review authored by his colleague Jeffrey Schwartz, MD, Qazi described PBC as “devastating” but also noted the field is expanding and there are medications repurposed from other disease treatments that could be beneficial in PBC, as explored in this study with the use of ursodiol in combination with fenofibrate.

“I think this sort of strategy shows you once again, the novelness of using or combining therapies in different ways,” Qazi explained, referencing another article from this installment of Qazi Corner about the use of tofacitinib in acute severe ulcerative colitis and comparing it to the use of fenofibrate in PBC. “By combining these 2 therapies together, the authors are trying to give another example of a strategy that we can use to manage PBC.”

Qazi noted this was a strategy he was especially interested in looking into due to the potential for biochemical benefit without a significant cost burden to patients, citing the value of repurposing medication “we already have” but also calling attention to the need for future research looking at factors beyond biochemical response.

Still, he concluded: “The biggest clinical implication in this study is that fenofibrate can be used as first-line therapy with limited side effect profiles on the whole for patients, and they provide significant benefit in patients who are already on ursodiol without a major significant biochemical response.”

Read Schwartz's article from Qazi Corner Issue 5 here

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