AASLD and AGA release new medication guidelines for PBC treatment

The American Association for the Study of Liver Diseases (AASLD) and the American Gastroenterological Association (AGA) have issued the first joint medication-focused guidelines for treating primary biliary cholangitis (PBC), the most common cholestatic disease in adults.

The guidelines provide evidence-based recommendations to help clinicians navigate a changing treatment landscape, particularly following the withdrawal of obeticholic acid from the U.S. market in late 2025. Key recommendations include using ursodeoxycholic acid as first-line therapy and considering peroxisome proliferator-activated receptor agonists as second-line or add-on therapy for patients who are intolerant to or do not respond adequately to ursodeoxycholic acid.

To improve diagnosis and management, the guidelines suggest using SP100 and GP210 antibodies for patients who test negative for antimitochondrial antibodies, which may help avoid liver biopsies. Additionally, clinicians are advised to measure liver stiffness to assess disease progression risk and consider linerixibat for managing moderate-to-severe itching. The framework emphasizes a personalized approach through shared decision-making, accounting for side effects, costs, and patient preferences.