The first drug for PBC doesn't work? Let's talk about the second step (Primary Biliary Cholangitis)

Do you have a liver disease called PBC, or Primary Biliary Cholangitis? If so, the first medication your doctor prescribed may not have worked as well as you hoped. Don't worry about it. Many people have had similar experiences. The important thing is to stay hopeful and be aware of what you can do next. Today, let's talk about what you can do at a time like this and what new treatments are available.

First of all, what is PBC in simple terms?

PBC is a complex, long-term condition in which our body's own immune system attacks the small bile ducts in our liver. Think of these bile ducts as small pipes inside our liver. Their main function is to carry bile, a fluid that helps digest food, out of the liver.

Now, in the case of PBC, our own immune system cells damage these pipes. Then these pipes become blocked, and bile does not flow properly and gets stuck inside the liver. Just like cars get stuck in traffic. When bile accumulates in this way, it starts to damage the liver cells. Over time, this damage can cause scarring of the liver. We call this fibrosis . When this condition becomes more severe, it can lead to the risk of cirrhosis, a condition called liver failure.

This is a little different from other autoimmune diseases. Because PBC does not respond well to the immune system-suppressing drugs that are used for other autoimmune diseases. One reason may be that the liver has already been damaged to some extent by the time the disease is diagnosed. But don't worry, with the advancement of science, there are now good treatments for this.

The first step in treatment: UDCA medication

There are several main goals in treating PBC: slowing the progression of the disease, controlling symptoms, and preventing complications from liver damage.

Once you've been diagnosed with PBC, the first medication your doctor will likely start you on is Ursodeoxycholic acid , or UDCA for short. You may know it by the brand name Ursodiol. This medication works by helping the liver release bile that's stuck in the liver and reducing the formation of scarring (fibrosis) in the liver. This is important, because scarring is what can eventually lead to cirrhosis and liver failure.

But the truth is, UDCA does not work for everyone. This is the main point we are talking about today.

Why is UDCA alone not enough?

Research has found that between 25% and 50% of patients taking UDCA do not get the expected results from the drug. This means that their liver function tests do not show significant improvement.

In this way, a person who does not respond well to UDCA has a fivefold increased risk of developing cirrhosis. And the risk of dying from the disease is threefold increased. So if UDCA is not working, it is important to talk to your doctor about the next steps, rather than just continuing to use it.

Are you wondering why UDCA isn't working properly? There could be several reasons for that.

If you have one or more of these reasons, it's time to consider a second-line treatment . The goal here is not just to improve your blood test results. It's also important to control symptoms that are affecting your quality of life, such as unbearable itching, excessive fatigue, and insomnia . Because UDCA does not provide much relief for these symptoms.

Second-line treatments: What are these new options?

Treatment options for PBC are rapidly evolving. Several new drugs are in the final stages of approval. Let's take a look at current and upcoming treatments.

Obeticholic acid (OCA)

If UDCA doesn't work well, or if you can't tolerate UDCA, the next main medication your doctor will consider is obeticholic acid , or OCA . It usually comes under the brand name Ocaliva.

Sometimes OCA can be given along with UDCA. That is, both drugs are used together. OCA belongs to a group of drugs called farnesoid X receptor agonists . In simple terms, its action is,

1. Reduces the amount of bile produced by the liver.

2. Helps push bile out of the liver.

In this way, when OCA is used alone or with UDCA, liver function improves and the rate of liver scarring decreases.

But one of the main side effects of OCA is that it can increase the itching in PBC patients. Therefore, if itching increases after starting this medication, you should definitely tell your doctor about it. Then he or she can change the dosage or give you a different treatment.

The field of PBC treatment is constantly evolving, so it's important for your health to stay in touch with your doctor and discuss new treatments.