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Primary biliary cholangitis: current insights and novel therapies.
Alessandro Granito1,2,3,4, Georgios Pappas1, Lucia Napoli5
1IRCCS Azienda Ospedaliero-Universitaria di Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
Expert Review of Clinical Immunology
|May 10, 2026
Summary
Primary biliary cholangitis (PBC) management is shifting towards personalized treatment. New therapies offer improved quality of life by targeting high-risk patients and addressing symptoms like fatigue and pruritus.
Area of Science:
- Hepatology and immunology
- Gastroenterology
- Internal Medicine
Background:
- Primary biliary cholangitis (PBC) can progress to cirrhosis despite ursodeoxycholic acid (UDCA) therapy.
- Some patients show inadequate response or intolerance to UDCA, requiring alternative treatments.
- A personalized management approach is needed for effective PBC treatment.
Purpose of the Study:
- To review recent literature on Primary Biliary Cholangitis (PBC).
- To highlight a novel treatment approach based on prognostic characterization.
- To discuss new therapies and symptom management for PBC.
Main Methods:
- Literature synthesis on recent advancements in PBC treatment.
- Analysis of prognostic characterization for identifying high-risk phenotypes.
- Review of approved second-line therapies and emerging agents.
Main Results:
- A prognostic approach identifies high-risk PBC phenotypes influencing UDCA response.
- Newly approved and investigational therapies show promise.
- Effective treatments for pruritus and fatigue in PBC are still needed.
Conclusions:
- PBC treatment should transition to prognostically based, individualized regimens.
- Novel therapies can improve biochemical responses and quality of life.
- Real-world evidence is crucial for validating trial findings in diverse patient subgroups.
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