Treatment

The main goal of treatment for primary biliary cholangitis (PBC) is to slow liver damage. Early treatment can lead to a normal quality of life. And new treatments continue to emerge.¹

This article covers common treatments for PBC. Medications are the main part of a treatment plan. Talk to your doctor about the right treatment plan for you.¹

Who treats PBC?

Your primary care doctor may be the first to notice signs of PBC. They may refer you to a specialist. Your care team may include:²

• Gastroenterologists – doctors who specialize in the digestive system
• Hepatologists – doctors who specialize in the liver
• Nurses and physician assistants (PAs) – professionals who perform ongoing monitoring and support
• Surgeons – doctors who may perform liver transplants

What are the goals of PBC treatment?

There is no cure for PBC. But treatments can slow progression. The main goals of treatment include:¹

• Slowing or stopping damage to the liver and bile ducts
• Treating symptoms
• Managing complications

Doctors will monitor you to see if treatments are working. They will ask about symptoms and perform tests. This can help make treatment decisions as your condition changes.^1,2

Lifestyle and diet changes

Most people with PBC enjoy normal activities for years after diagnosis. A healthy lifestyle can reduce symptoms. It can also prevent complications.^3,4

A healthy diet is important for people with PBC. Good nutrition helps your liver work well. Talk to your doctor about your diet. They may suggest:^3,4

• Avoiding or limiting alcohol
• Eating plenty of fruits, vegetables, and whole grains
• Avoiding raw or undercooked meats and fish
• Choosing foods with unsaturated fats, like nuts, avocados, and salmon
• Reducing saturated fats, sugary foods, and salty foods
• Getting plenty of vitamin D and calcium

Your doctor may suggest other ways to stay healthy. This may include:³

• Keeping active with daily exercise
• Doing light weight training to maintain bone density
• Getting vaccinations, especially hepatitis A and hepatitis B

Medications

Medications are the cornerstone of PBC treatment. They improve health outcomes for most people with PBC. Medications work better when started at the early stages.^1,2

Bile salts

Ursodeoxycholic acid (also known as ursodiol or UDCA) is the first-line treatment for PBC. It has been used for decades to treat PBC. Brand names include Actigall™ and Urso™. ^1,2,5

UDCA works by moving bile through the liver. It improves liver function and delays the progression of PBC. It is effective in the majority of people with PBC.¹

Obeticholic acid (OCA) was previously an option if UDCA does not work sufficiently. It targets a protein that controls bile acid flow. The brand name is Ocaliva™. OCA has been removed from the market in the US. This is because of the risk of serious liver side effects.^1,5,6

PPAR agonists

PPAR is a protein that controls inflammation in the liver. Targeting PPAR may improve liver function and reduce symptoms. Drugs that target PPAR may be used when UDCA does not work well. Examples include seladelpar (Livdelzi™) and elafibrinor (Iqirvo™).^1,5,6

Some PPAR agonists are approved to treat conditions other than PBC. Your doctor may use them “off-label” to treat PBC. These include fibrates: bezafibrate (Bezalip™) and fenofibrate (Tricor™, Lipofen™).^1,2,5

Other therapies

If the above medicines do not work, your doctor may suggest glucocorticoids. These drugs reduce immune system activity. The glucocorticoid studied for PBC treatment is budesonide (Entocort™). However, more research is needed to determine the benefits of budesonide on PBC.¹

Surgery

PBC progression can lead to liver scarring and liver failure. If this happens, you may need a liver transplant. During a liver transplant, a doctor replaces your liver with a healthy one from a donor.^1,2

Liver transplants work well for people with PBC. Life expectancy after liver transplants is normal. However, PBC can come back years later in the new liver.^1,2

Treating symptoms

Your doctor can recommend treatments to control symptoms of PBC. These treatments will not improve liver function. But they can increase comfort. Treatments for symptoms include:²

• Antihistamines and other medicines to reduce itching
• Artificial tears to ease dry eyes
• Saliva substitutes to help with dry mouth

Treating complications

PBC progression can lead to other health conditions. Managing complications is an important part of treatment. Your doctor may recommend:^1,7

• Vitamin D and calcium supplements to treat bone loss
• Medicines to lower cholesterol, such as statins
• Surgical and other therapies to remove fatty skin deposits
• Diuretic drugs to remove fluid from the abdomen or legs

Complementary and integrative medicine

Complementary medicine uses therapies outside of standard care. They are combined with standard treatment. They do not replace standard treatment.⁸

Most complementary therapies need more research. Herbal products, supplements, and mind-body practices are common complementary therapies. Talk to your healthcare team before using them, especially as they are not regulated by the FDA and may have ingredients that could do additional harm to your liver.⁸

Integrative medicine combines standard and complementary treatments. This strategy prioritizes your personal preference. Integrative medicine can help with coping and stress. It can also increase your sense of control.⁸

Emerging treatments

Researchers are studying many new treatments for PBC. Clinical trials are ongoing for more drugs that work like the ones mentioned above. These include saroglitazar, another PPAR agonist.⁵

Researchers are also studying drugs that treat PBC in new ways:^5,9-11

• Fibroblast growth factor agonists – activate proteins that reduce how much bile acid your body makes (example: aldafermin)
• NADPH oxidase inhibitors – block enzymes involved in liver scarring (example: setanaxib)
• Janus kinase (JAK) inhibitors – block proteins that control inflammation (example: baricitinib)