Personalized diagnosis and treatment strategies of primary biliary cholangitis

Linhua ZHENG; Ying HAN

doi:10.12449/JCH250707

Volume 41 Issue 7

Jul. 2025

Turn off MathJax

Article Contents

Article Navigation > Journal of Clinical Hepatology > 2025 > 41(7): 1270-1274

PDF( 568 KB)

Personalized diagnosis and treatment strategies of primary biliary cholangitis

DOI: 10.12449/JCH250707

Linhua ZHENG,
Ying HAN^{,
,}

Department of Gastroenterology，Xijing Hospital，Air Force Medical University，Xi’an 710032，China

Research funding:

National Natural Science Foundation of China (82270551);

Science and Technology Innovation Team of Shaanxi Province (2024RS-CXTD-79)

More Information

Corresponding author: HAN Ying， hanying@fmmu.edu.cn （ORCID： 0000-0003-3046-9507）
Received Date: 2025-04-18
Accepted Date: 2025-05-20
Published Date: 2025-07-25

Abstract

Abstract

At present， there are still certain problems in the diagnosis and treatment of primary biliary cholangitis （PBC）， such as a low rate of early diagnosis， limitations in the selection of therapeutic drugs. For patients with atypical PBC and a normal level of alkaline phosphatase， IgM， age， and sex can be used as important indicators for the diagnosis of PBC. By shortening the cycle for evaluation， “Xi’an criteria” can facilitate early identification of patients who have a suboptimal response to ursodesoxycholic acid after 1-month treatment and allows clinicians to initiate second-line therapeutic agent. It provides significant platform in the clinical evaluation of prognostic information. Based on the optimization of existing models for prognostic evaluation， new dynamic models should be established based on serum indicators and liver stiffness to facilitate accurate prognostic assessment and active new drug research and development.
- Primary Biliary Cholangitis,
- Forecasting,
- Therapeutics

FullText(HTML)

References(31)

References

[1]	YOU H, MA X, EFE C, et al. APASL clinical practice guidance: The diagnosis and management of patients with primary biliary cholangitis[J]. Hepatol Int, 2022, 16( 1): 1- 23. DOI: 10.1007/s12072-021-10276-6.
[2]	LLEO A, WANG GQ, GERSHWIN ME, et al. Primary biliary cholangitis[J]. Lancet, 2020, 396( 10266): 1915- 1926. DOI: 10.1016/S0140-6736(20)31607-X.
[3]	HARMS MH, van BUUREN HR, CORPECHOT C, et al. Ursodeoxycholic acid therapy and liver transplant-free survival in patients with primary biliary cholangitis[J]. J Hepatol, 2019, 71( 2): 357- 365. DOI: 10.1016/j.jhep.2019.04.001.
[4]	YANG CM, GUO GY, LI B, et al. Prediction and evaluation of high-risk patients with primary biliary cholangitis receiving ursodeoxycholic acid therapy: An early criterion[J]. Hepatol Int, 2023, 17( 1): 237- 248. DOI: 10.1007/s12072-022-10431-7.
[5]	KUIPER EMM, HANSEN BE, de VRIES RA, et al. Improved prognosis of patients with primary biliary cirrhosis that have a biochemical response to ursodeoxycholic acid[J]. Gastroenterology, 2009, 136( 4): 1281- 1287. DOI: 10.1053/j.gastro.2009.01.003.
[6]	LAMMERS WJ, HIRSCHFIELD GM, CORPECHOT C, et al. Development and validation of a scoring system to predict outcomes of patients with primary biliary cirrhosis receiving ursodeoxycholic acid therapy[J]. Gastroenterology, 2015, 149( 7): 1804- 1812. e 4. DOI: 10.1053/j.gastro.2015.07.061.
[7]	CARBONE M, SHARP SJ, FLACK S, et al. The UK-PBC risk scores: Derivation and validation of a scoring system for long-term prediction of end-stage liver disease in primary biliary cholangitis[J]. Hepatology, 2016, 63( 3): 930- 950. DOI: 10.1002/hep.28017.
[8]	DING DW, JIA G, GUO GY, et al. Risk stratification for patients with primary biliary cholangitis: Early versus advanced-stage or non-cirrhosis versus cirrhosis?[J]. Hepatol Int, 2025. DOI: 10.1007/s12072-025-10820-8.
[9]	ZHANG LN, SHI TY, SHI XH, et al. Early biochemical response to ursodeoxycholic acid and long-term prognosis of primary biliary cirrhosis: Results of a 14-year cohort study[J]. Hepatology, 2013, 58( 1): 264- 272. DOI: 10.1002/hep.26322.
[10]	CRISTOFERI L, CALVARUSO V, OVERI D, et al. Accuracy of transient elastography in assessing fibrosis at diagnosis in Naïve patients with primary biliary cholangitis: A dual cut-off approach[J]. Hepatology, 2021, 74( 3): 1496- 1508. DOI: 10.1002/hep.31810.
[11]	CORPECHOT C, CARRAT F, GAOUAR F, et al. Liver stiffness measurement by vibration-controlled transient elastography improves outcome prediction in primary biliary cholangitis[J]. J Hepatol, 2022, 77( 6): 1545- 1553. DOI: 10.1016/j.jhep.2022.06.017.
[12]	DING DW, GUO GY, CUI LN, et al. Prognostic significance of liver stiffness in patients with primary biliary cholangitis: Validation of Baveno VII criteria[J]. Hepatol Int, 2024, 18( 1): 206- 215. DOI: 10.1007/s12072-023-10587-w.
[13]	LEVY C, BOWLUS CL. Primary biliary cholangitis: Personalizing second-line therapies[J]. Hepatology, 2024. DOI: 10.1097/HEP.0000000000001166.
[14]	CORPECHOT C, LEMOINNE S, SORET PA, et al. Adequate versus deep response to ursodeoxycholic acid in primary biliary cholangitis: To what extent and under what conditions is normal alkaline phosphatase level associated with complication-free survival gain?[J]. Hepatology, 2024, 79( 1): 39- 48. DOI: 10.1097/HEP.0000000000000529.
[15]	CARBONE M, MELLS GF, PELLS G, et al. Sex and age are determinants of the clinical phenotype of primary biliary cirrhosis and response to ursodeoxycholic acid[J]. Gastroenterology, 2013, 144( 3): 560- 569. e7; quize13-4. DOI: 10.1053/j.gastro.2012.12.005.
[16]	CHEUNG AC, LAMMERS WJ, MURILLO PEREZ CF, et al. Effects of age and sex of response to ursodeoxycholic acid and transplant-free survival in patients with primary biliary cholangitis[J]. Clin Gastroenterol Hepatol, 2019, 17( 10): 2076- 2084. e 2. DOI: 10.1016/j.cgh.2018.12.028.
[17]	ZHENG LH, TIAN SY, YANG CM, et al. Hypercholesterolemia is associated with dysregulation of lipid metabolism and poor prognosis in primary biliary cholangitis[J]. Clin Gastroenterol Hepatol, 2024, 22( 6): 1265- 1274. e 19. DOI: 10.1016/j.cgh.2024.01.039.
[18]	TIAN SY, HU YN, ZHANG M, et al. Integrative bioinformatics analysis and experimental validation of key biomarkers for risk stratification in primary biliary cholangitis[J]. Arthritis Res Ther, 2023, 25( 1): 186. DOI: 10.1186/s13075-023-03163-y.
[19]	SHANG YL, LEUNG PSC, GERSHWIN ME, et al. Primary biliary cholangitis: Personalized medicine for optimal therapeutic opportunities[J]. Sci Bull(Beijing), 2022, 67( 24): 2498- 2501. DOI: 10.1016/j.scib.2022.11.029.
[20]	NEVENS F, ANDREONE P, MAZZELLA G, et al. A placebo-controlled trial of obeticholic acid in primary biliary cholangitis[J]. N Engl J Med, 2016, 375( 7): 631- 643. DOI: 10.1056/NEJMoa1509840.
[21]	ROBERTS SB, ISMAIL M, KANAGALINGAM G, et al. Real-world effectiveness of obeticholic acid in patients with primary biliary cholangitis[J]. Hepatol Commun, 2020, 4( 9): 1332- 1345. DOI: 10.1002/hep4.1518.
[22]	KOWDLEY KV, HIRSCHFIELD GM, COOMBS C, et al. COBALT: A confirmatory trial of obeticholic acid in primary biliary cholangitis with placebo and external controls[J]. Am J Gastroenterol, 2025, 120( 2): 390- 400. DOI: 10.14309/ajg.0000000000003029.
[23]	CORPECHOT C, CHAZOUILLÈRES O, ROUSSEAU A, et al. A placebo-controlled trial of bezafibrate in primary biliary cholangitis[J]. N Engl J Med, 2018, 378( 23): 2171- 2181. DOI: 10.1056/NEJMoa1714519.
[24]	WANG L, SUN KS, TIAN A, et al. Fenofibrate improves GLOBE and UK-PBC scores and histological features in primary biliary cholangitis[J]. Minerva Med, 2022, 113( 6): 974- 982. DOI: 10.23736/S0026-4806.21.07316-X.
[25]	LIU YS, GUO GY, ZHENG LH, et al. Effectiveness of fenofibrate in treatment-naive patients with primary biliary cholangitis: A randomized clinical trial[J]. Am J Gastroenterol, 2023, 118( 11): 1973- 1979. DOI: 10.14309/ajg.0000000000002238.
[26]	XUAN GY, DING DW, LIU N, et al. Efficacy and safety of fenofibrate add-on therapy in patients with primary biliary cholangitis refractory to ursodeoxycholic acid: A retrospective study and updated meta-analysis[J]. Front Pharmacol, 2022, 13: 948362. DOI: 10.3389/fphar.2022.948362.
[27]	DING DW, XUAN GY, HU YN, et al. Immunoglobulin M: A neglected serum biomarker in treatment-naive primary biliary cholangitis with normal alkaline phosphatase[J]. Hepatol Commun, 2022, 6( 6): 1403- 1412. DOI: 10.1002/hep4.1907.
[28]	de VRIES E, BOLIER R, GOET J, et al. Fibrates for itch(FITCH) in fibrosing cholangiopathies: A double-blind, randomized, placebo-controlled trial[J]. Gastroenterology, 2021, 160( 3): 734- 743. e 6. DOI: 10.1053/j.gastro.2020.10.001.
[29]	KOWDLEY KV, BOWLUS CL, LEVY C, et al. Efficacy and safety of elafibranor in primary biliary cholangitis[J]. N Engl J Med, 2024, 390( 9): 795- 805. DOI: 10.1056/NEJMoa2306185.
[30]	HIRSCHFIELD GM, BOWLUS CL, MAYO MJ, et al. A phase 3 trial of seladelpar in primary biliary cholangitis[J]. N Engl J Med, 2024, 390( 9): 783- 794. DOI: 10.1056/NEJMoa2312100.
[31]	KREMER AE, MAYO MJ, HIRSCHFIELD GM, et al. Seladelpar treatment reduces IL-31 and pruritus in patients with primary biliary cholangitis[J]. Hepatology, 2024, 80( 1): 27- 37. DOI: 10.1097/HEP.0000000000000728.

Relative Articles

Supplements(0)

Cited By

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Tables(1)

Get Citation

PDF

XML

Article Metrics

Article views (459) PDF downloads(125)

Personalized diagnosis and treatment strategies of primary biliary cholangitis

DOI: 10.12449/JCH250707

Abstract

References

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

Personalized diagnosis and treatment strategies of primary biliary cholangitis

DOI: 10.12449/JCH250707

Abstract

References

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

About Journal

Submission Guideline

Journal Online

Hepatobiliary College

Guidelines

Export File

Citation

Format

Content