John Vierling, MD, FACP, FAASLD, AGAF

Treatment Response to PPAR Agonists and Other Therapies in PBC

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How do you determine if treatment is effective in PBC?

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Primary biliary cholangitis (PBC) is an autoimmune liver disease characterized by the progressive destruction of small and medium-sized bile ducts within the liver. This destruction is primarily mediated by autoreactive T lymphocytes targeting the epithelial cells of the bile ducts. The ensuing cholestasis leads to the accumulation of toxic bile acids, causing hepatocellular damage and inflammation. Over time, this chronic inflammatory process results in fibrosis and eventually cirrhosis. The pathophysiology of PBC is influenced by genetic predispositions and environmental factors, contributing to its complex etiology and progression.

The panel of experts discuss how to determine the effectiveness of treatment in primary biliary cholangitis (PBC), focusing on key clinical markers, biochemical responses, and patient outcomes.

Integration of PPAR Agonists in Treatment Landscape of PBC

How do you envision the uptake and integration of PPAR agonists into the current treatment landscape for PBC? What would you recommend for someone who is taking a fibrate for PBC?

The panel of experts explore the potential integration of peroxisome proliferator-activated receptor (PPAR) agonists into the current treatment landscape for primary biliary cholangitis (PBC) and provides recommendations for patients currently taking fibrates for managing the disease.

Elafibranor and Choosing Amongst PPAR Agonists in PBC

The FDA recently approved another PPAR-δ agonist, elafibranor, for PBC. Could you discuss the long-term data of this agent? 

How do clinical findings for elafibranor compare with those of seladelpar?

How do you choose the right PPAR agonist for treating PBC, and how do you know if the treatment is working?

Elafibranor, a PPAR-δ agonist, has been approved by the FDA for primary biliary cholangitis (PBC), showing promising long-term efficacy and safety data. Clinical findings indicate that elafibranor and seladelpar both improve liver function and reduce symptoms in PBC patients, but they differ in their receptor selectivity and side effect profiles. Choosing the appropriate PPAR agonist involves considering patient-specific factors, such as comorbidities and tolerance to side effects. Monitoring treatment efficacy involves regular assessment of liver function tests and symptom improvement to ensure optimal patient outcomes.

The panel of experts examine the long-term data for the recently FDA-approved PPAR-δ agonist elafibranor in the treatment of primary biliary cholangitis (PBC), comparing its clinical findings with those of seladelpar, and explores how to choose the right peroxisome proliferator-activated receptor (PPAR) agonist and assess treatment effectiveness.

Pruritus Control With PPAR Agonists in PBC

Pruritus is a debilitating symptom experienced by over 80% of patients with cholestatic liver diseases, such as PBC. What is the role of effectively treating pruritus in the long-term management of PBC?

Effective management of pruritus in patients with primary biliary cholangitis (PBC) is crucial for improving quality of life and adherence to treatment regimens. Pruritus, a common and distressing symptom in cholestatic liver diseases, can significantly impact patients' physical and mental well-being. Addressing this symptom can lead to better patient outcomes and may prevent complications associated with chronic itching. Treatment strategies include pharmacological interventions and lifestyle modifications, tailored to individual patient needs. Long-term management requires a comprehensive approach, integrating symptom control with disease-modifying therapies.

The panel of experts discuss the role of effectively treating pruritus, a common and debilitating symptom in over 80% of patients with cholestatic liver diseases like primary biliary cholangitis (PBC), and its importance in the long-term management of the disease.

John Vierling, MD, FACP, FAASLD, AGAF

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