Gastroenterology and hepatology
Primary biliary cholangitis
Cholestatic LFTs plus antimitochondrial antibody, ursodeoxycholic acid at 13 to 15 mg/kg, judging response at 12 months, second-line elafibranor (PBS 2025) and the fall of obeticholic acid, pruritus, bone health and transplant referral.
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Autoimmune destruction of small intrahepatic bile ducts, causing chronic cholestasis that can progress to cirrhosis. The old name was primary biliary cirrhosis.
- Typically a woman aged 40 to 60 with fatigue, itch, or an incidentally raised ALP.
- Diagnosis: cholestatic LFTs plus antimitochondrial antibody (AMA). Biopsy is rarely needed.
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Sources
- Levy C et al. AGA/AASLD Clinical Practice Guideline on Management of Primary Biliary Cholangitis. Gastroenterology 2026;171:817-39 (also Hepatology 2026)American Gastroenterological Association and American Association for the Study of Liver Diseases, 2026
- EASL Clinical Practice Guidelines: the diagnosis and management of patients with primary biliary cholangitis. J Hepatol 2017;67:145-72 (used for diagnostic criteria; predates the PPAR agonists)European Association for the Study of the Liver, 2017
- Elafibranor (Iqirvo): PBS listing for primary biliary cholangitis, effective 1 November 2025AU/NZPharmaceutical Benefits Scheme, 2025
- PBAC Public Summary Documents by product (search: seladelpar, elafibranor)AU/NZPharmaceutical Benefits Advisory Committee, 2025
- Kowdley KV et al. Efficacy and safety of elafibranor in primary biliary cholangitis (ELATIVE). N Engl J Med 2024;390:795-805New England Journal of Medicine, 2024
- Iqirvo (elafibranor) prescribing information: ELATIVE entry criteria (ALP at least 1.67 times ULN, bilirubin no more than 2 times ULN), not recommended in decompensated cirrhosis, myopathy, fracture, fetal harm and liver injury warningsUS Food and Drug Administration (DailyMed), accessed November 2026
- Hirschfield GM et al. A phase 3 trial of seladelpar in primary biliary cholangitis (RESPONSE). N Engl J Med 2024;390:783-94New England Journal of Medicine, 2024
- Corpechot C et al. A placebo-controlled trial of bezafibrate in primary biliary cholangitis (BEZURSO). N Engl J Med 2018;378:2171-81New England Journal of Medicine, 2018
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy