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Old and new treatments for primary biliary cholangitis
Author(s) -
Chascsa David,
Carey Elizabeth J.,
Lindor Keith D.
Publication year - 2017
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13294
Subject(s) - obeticholic acid , ursodeoxycholic acid , medicine , gastroenterology , primary biliary cirrhosis , liver transplantation , bile acid , alkaline phosphatase , chenodeoxycholic acid , transplantation , biology , biochemistry , receptor , enzyme , agonist
Primary biliary cholangitis (formerly primary biliary cirrhosis) is a rare progressive cholestatic liver disease, whose hallmark features include a persistently elevated alkaline phosphatase level, presence of anti‐mitochondrial antibodies and characteristic histology. Since 1998, ursodeoxycholic acid ( UDCA ), a bile acid, has been the only available therapeutic agent. Primary biliary cholangitis is associated with the development of end‐stage liver disease, increased morbidity and mortality. UDCA has been shown to improve serum biochemistries, histology and delay the need for liver transplantation. The clinical issue is that approximately 25%‐40% of patients do not respond to this standard therapy. In recent years, many trials have investigated alternative and adjunctive treatments, leading to the recent approval of obeticholic acid, an analogue of chenodeoxycholic acid, which has shown significant and sustained reductions in alkaline phosphatase levels in combination with UDCA . Obeticholic acid has rapidly been embraced as a new agent to improve the biochemical profile in refractory patients, in addition to being approved for use as monotherapy in patients who cannot tolerate UDCA . There are several other studies and targets which are being investigated. This review is intended to highlight the benefits of UDCA , educate the reader on the newly available obeticholic acid, and to summarize the many ongoing trials and therapeutic targets being investigated in attempts to control and cure primary biliary cholangitis.