First AD

Second AD

Second-Line Treatments and Management of Symptoms 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?

Long-term treatment with OCA is associated with pruritus (77% of patients) and fatigue (33% of patients) (

), 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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Video Series

Expanding Treatment Options for Primary Biliary Cholangitis with Novel Therapies

Obeticholic acid (OCA) is a second-line therapy for primary biliary cholangitis (PBC), used when first-line treatments are inadequate. It functions by activating the farnesoid X receptor, reducing bile acid synthesis. Long-term OCA use can cause pruritus and fatigue, necessitating symptom management strategies. Patient counseling is crucial, especially for those with pre-existing pruritus. Fibrates, used off-label, offer an alternative treatment but present challenges like adverse effects. Effectiveness is assessed through biochemical response and symptom management. Treatment strategy changes are indicated by inadequate response or adverse effects.

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.