In primary biliary cholangitis (PBC), the choice of therapeutic agent depends critically on the patient's hepatic status. The presence of decompensated liver disease or advanced cirrhosis directly limits which alternatives can be considered, and careful patient-level assessment is required before selecting among available options.
Off-label alternatives to standard management exist for PBC. Fibrates are one such class of agents — however, their use is specifically discouraged when decompensated liver disease is present.
Obeticholic acid (OCA) represents a further option in this setting, though it carries a contraindication in patients with advanced cirrhosis. Which agent applies, under what conditions, and how the full algorithm proceeds requires more than what can be summarised here.
The complete protocol — including eligibility criteria, sequencing, and clinical decision points — is available below.
DOI: 10.1002/hep.32117