AGA/AASLD joint guideline evaluates newer medications for primary biliary cholangitis

The guideline addresses recent changes in the PBC treatment landscape and key challenges clinicians face, including diagnosing patients with less common antibody profiles, determining when to move beyond first-line therapy, and managing PBC-related itching. Because most people living with PBC are cared for by general gastroenterologists rather than hepatology specialists, the guideline is designed to ensure the broader GI community has access to the latest evidence and standards of care.

Key updates: 

• Use SP100 and GP210 antibodies to help diagnose suspected PBC in those who test negative for antimitochondrial antibodies. These tests may help some patients avoid a liver biopsy.
• Use ursodeoxycholic acid as a first-line therapy for people with PBC.
• Measure liver stiffness to help determine the individual's risk of disease progression.
• Consider peroxisome proliferator-activated receptor agonists as add-on therapy for people with PBC who do not respond adequately to ursodeoxycholic acid or as an alternative for those who cannot tolerate it.
• Consider linerixibat for people with moderate-to-severe itching caused by PBC. Clinicians and patients should use shared decision-making to weigh potential benefits against factors such as gastrointestinal side effects, cost, and individual patient preferences.
• Use ursodeoxycholic acid prophylaxis after a liver transplant to reduce the risk of PBC recurrence and graft failure. 

Knowledge gaps and future directions 

Understanding PBC

Source:

American Gastroenterological Association

Journal reference: