Primary Biliary Cholangitis: Management When UDCA Therapy Has Not Achieved Targets
Not all patients with primary biliary cholangitis (PBC) achieve adequate biochemical control on first-line therapy. When the initial treatment fails to bring liver biochemistry within acceptable limits, escalation to a second-line protocol is required.
First-line therapy with oral ursodeoxycholic acid (UDCA), taken continuously for life, did not achieve the required outcomes: transplant-free survival comparable to a healthy population, with ALP below 1.5 × ULN and a normal bilirubin after one year of treatment.
The treatment targets attainment of an ALP value below 1.67 × ULN — with a reduction of at least 15% from baseline — and a normal serum bilirubin level, both assessed at 12 months of therapy.