FAQ: What Second-Line Therapies Are Available for PBC?

Tessa Janovsky, a physician assistant at Arizona Liver Health in Phoenix, Arizona, discusses second-line therapies for primary biliary cholangitis (PBC) in patients with an inadequate response or intolerance to ursodiol, also known as ursodeoxycholic acid (UDCA). She reviews elafibranor (Iqirvo) and seladelpar (Livdelzi), two PPAR agonists approved by the FDA in 2024, including their once-daily dosing and effects on alkaline phosphatase (ALP). The discussion explores the importance of reassessing biochemical response, considering timely treatment escalation, and understanding symptom-related findings involving pruritus and fatigue. Tessa also addresses the 2025 U.S. withdrawal of obeticholic acid (Ocaliva) and the evolving options for second-line PBC treatment. Designed for nurse practitioners, physician assistants, and other healthcare professionals caring for patients with cholestatic liver disease, this video offers an overview of PBC treatment options beyond ursodiol, monitoring treatment response, and considerations for individualizing patient care.