Desktop disease specific banner PBC 2x
Hormonal and Rare Conditions Primary Biliary Cholangitis Treatment
Treatment
Treating PBC

Treatment

There is no cure for PBC, but there are treatment options that can help slow the progression of your disease.1,2

Treatment typically takes the form of medications to slow disease progression, prevent complications, and treat symptoms of the disease.3 However, if you have severe liver damage, your doctor may recommend a liver transplant.4

The type of treatment you receive will depend on 

  • Your symptoms
  • Stage of your disease

Medications

The current first line treatment for PBC is with a naturally occurring bile acid which is given in tablet form5,6 This medicine can help clear bile from your liver and delay liver damage.1,2,4

About half of patients respond well to this first line treatment.2 During your first 6 months of treatment, your response will be monitored, usually by measuring alkaline phosphatase (ALP) levels.5,7 If these remain elevated, it may indicate that your liver and bile ducts are still being damaged.6 Response to treatment  is usually measured every 6-12 months after the initial 6 months of therapy.

If your levels of ALP remain elevated while taking first line treatment, or you are unable to tolerate it, there are second line oral treatments available3. These treatments are taken in combination with the initial first line treatment, when possible. Your doctor will be able to provide more information. 

Liver transplant

If you have advanced PBC with severe liver damage or a debilitating itch that significantly impacts your quality of life, your doctor may recommend a liver transplant. However, with effective treatments available, this is now rare 4,8

Your doctor will continually monitor your progress and review your medications to make sure you are on the best treatment plan for you.

A liver transplant can have very positive long-term outcomes and can sometimes stop symptoms such as pruritus. However, fatigue is often still associated with patients post-transplantation.4,9 PBC can come back in the new liver, but it typically progresses more slowly and is unlikely to reach the advanced stages.1,3,4

References

  1. Mayo Clinic. Primary biliary cholangitis. Available at: https://www.mayoclinic.org/diseases-conditions/primary-biliary-cholangitis/symptoms-causes/syc-20376874. Last accessed April 2025.
  2. Cleveland Clinic. Primary Biliary Cholangitis (PBC). Available at: https://my.clevelandclinic.org/health/diseases/17715-primary-biliary-cholangitis-pbc. Last accessed April 2025.
  3. British Liver Trust. Treating primary biliary cholangitis. Available at: https://britishlivertrust.org.uk/information-and-support/liver-conditions/primary-biliary-cholangitis/treatment. Last accessed April 2025.
  4. NHS. Primary biliary cholangitis. Available at: https://www.nhs.uk/conditions/primary-biliary-cholangitis-pbc/treatment/. Last accessed April 2025.
  5. Lindor KD, Gershwin ME, Poupon R, et al. Primary biliary cirrhosis. Hepatology. 2009;50(1):291-308.
  6. Poupon R. Primary biliary cirrhosis: a 2010 update. J Hepatol. 2010;52(5):745-758.
  7. Parés A, Caballería L, Rodés J. Excellent long-term survival in patients with primary biliary cirrhosis and biochemical response to ursodeoxycholic Acid. Gastroenterology. 2006;130(3):715-720.
  8. Patient.info. Primary biliary cholangitis. Available at: https://patient.info/digestive-health/abnormal-liver-function-tests-leaflet/primary-biliary-cholangitis. Last accessed April 2025.
  9. Ali AH, Carey EJ, Lindor KD. Diagnosis and management of primary biliary cirrhosis. Expert Rev Clin Immunol. 2014;10(12):1667-1678.