Gilead Sciences

This information is intended for US healthcare professionals.

Gilead Sciences

This information is intended for US healthcare professionals.

  2. Primary Biliary Cholangitis
  3. PBC Mangement

Management of Primary Biliary Cholangitis (PBC)

PBC is a disease that requires lifelong therapy. In line with clinical guidelines, the goal of lifelong therapy is to help reduce the risk of progressive liver disease and relieve patients of disease-associated symptoms that can reduce their QoL.1

Current Treatment Goals in PBC

Normalize ALP and Bilirubina

Achieve Symptom Control to Help Improve QoLb,c

Halt Disease Progressionc

Surrogate markers of treatment and clinical outcomes such as ALP and bilirubin, along with symptom control can allow for risk stratification of patients without the need for extended follow-up. Testing of surrogate biochemical markers can be implemented by those treating PBC to assess for the need and benefit of therapies.1,2

Lifestyle Management Recommendations

According to the AASLD guidelines, pruritus and fatigue are associated with the greatest impact on a patient’s QoL. Understanding lifestyle modifications to alleviate some of the largest symptoms in PBC may improve health outcomes for patients.3

Lifestyle management for
pruritus3-5:
  • Avoid heat, stress, woolen fabrics, tight or itchy clothing, tobacco and alcohol, scented detergents
  • Use of emollients/moisturizers, topical anesthetics and cooling agents, cotton fabric, loose clothing, bathing with tepid water, ice packs, relaxation techniques
Lifestyle management for fatigue3:
  • Empathy and counseling to allow patients to take ownership of PBC
  • Arranging key tasks earlier in the day, as fatigue increases throughout the day
  • Using available energy to its best advantage
  • Morning bright light therapy
  • Cognitive behavioral therapy

AASLD, American Association for the Study of Liver Diseases; ALP, alkaline phosphatase; EASL, European Association for the Study of the Liver; QoL, quality of life; ULN, upper limit of normal.

aBilirubin and ALP have been established as surrogate endpoints likely to predict clinical benefit, with widely accepted thresholds as 1x ULN and 1.67x the ULN.2

bThe symptoms associated with PBC, namely fatigue and pruritus, can impact QoL but there lies a significant variation in patient symptom management between centers and clinicians.1,3

cTreatment goals per EASL.1

References:

  1. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis. J Hepatol. 2017;67(1):145-172. doi:10.1016/j.jhep.2017.03.022
  2. Murillo Perez CF, Harms MH, Lindor KD, et al. GLOBAL PBC Study Group. Goals of treatment for improved survival in primary biliary cholangitis: treatment target should be bilirubin within the normal range and normalization of alkaline phosphatase. Am J Gastroenterol. 2020;115(7):1066-1074. doi:10.14309/ajg.0000000000000557
  3. Faisal A. Understanding fatigue and pruritus in primary biliary cholangitis. Clin Liver Dis (Hoboken). 2024;23(1):e0216. doi:10.1097/CLD.0000000000000216
  4. Lindor KD, Bowlus CL, Boyer J, Levy C, Mayo M. Primary Biliary Cholangitis: 2018 Practice Guidance from the American Association for the Study of Liver Diseases. Hepatology. 2019;69(1):394-419. doi:10.1002/hep.30145
  5. Düll MM, Kremer AE. Evaluation and management of pruritus in primary biliary cholangitis. Clin Liver Dis. 2022;26(4):727-745. doi:10.1016/j.cld.2022.06.009