Ileal Bile Acid Transporter (IBAT) Inhibitors for PBC

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Primary biliary cholangitis (PBC) is a rare long-term liver disease. It slowly damages the bile ducts in the liver. This can lead to a buildup of bile acids.¹

One of the most difficult symptoms of PBC is itching. Doctors call this pruritus. For many people with PBC, the itch is very bad. It can make it hard to sleep or work.¹

How do IBAT inhibitors work?

IBAT stands for ileal bile acid transporter. Bile acids are made in your liver. They travel to the small intestine to help digest food. Most bile acids are then taken back into the blood in the last part of the small bowel. This part is called the ileum.²

The IBAT protein helps move these bile acids back into the body. People with PBC often have too many bile acids in their blood. This causes the skin to itch. IBAT inhibitors block the IBAT protein. This means fewer bile acids return to the blood. Instead, they leave the body through stool waste. This helps lower the amount of bile acids that cause itching.²

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Examples of IBAT inhibitors

As of March 2026, there is 1 drug that has been approved by the US Food and Drug Administration (FDA) to treat the itching from PBC. This drug is called linerixibat (Lynavoy). It is the first drug made just to treat the itching from PBC.³

The FDA approved Lynavoy based on results from clinical studies. One major study was the GLISTEN trial. This study looked at 238 people with PBC who had moderate to severe itching.⁴

Researchers found that people taking Lynavoy had much less itching than those taking a placebo. A placebo is a pill with no medicine in it. Many people in the study reported that their quality of life improved. They could sleep better because they did not itch as much at night. Improvements were seen as early as 2 weeks into the treatment.⁴

What are the possible side effects?

Side effects can happen with any drug. The most common side effect of Lynavoy is diarrhea. This happens because more bile acids stay in the gut. Other side effects may include:^3,4

Abdominal pain (stomach pain)
Nausea
Headaches
Dizziness

Most cases of diarrhea and stomach pain are mild to moderate. Symptoms often happen within the first 20 days of treatment.^3,4

These are not all the possible side effects of Lynavoy. Talk to your doctor about what to expect when taking Lynavoy. You also should call your doctor if you have any changes that concern you when taking Lynavoy.^3,4

Other IBAT inhibitors for PBC

Other IBAT inhibitors are also being studied for treating the PBC itch. For example, a drug called volixibat is currently being researched. It has not yet been FDA-approved for PBC.⁵

Other things to know

Before beginning treatment for PBC, tell your doctor about all your health conditions. Tell them about any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.

A big step for PBC treatment

The approval of Lynavoy is a big step for the PBC community. It is the first drug to target the itch specifically. For years, many people with PBC had to live with this symptom without a clear treatment. Now, there is a way to lower bile acids and potentially improve daily life.

If you struggle with the PBC itch, talk to your healthcare team. They can help you decide if an IBAT inhibitor is right for you.

Reviewed by: HU Medical Review Board | Last reviewed: April 2026

Treatment results and side effects can vary from person to person. This treatment information is not meant to replace professional medical advice. Talk to your doctor about what to expect before starting and while taking any treatment.