2019 Webinar: The 2018 Primary Biliary Cholangitis Practice Guidance: Highlights-The 2018 Primary Biliary Cholangitis Practice Guidance: Highlights

Video Transcription

Video Summary

This is a summary of an AASLD webinar on the 2018 Primary Biliary Cholangitis (PBC) Practice Guidance. The main difference between the 2009 guidelines and the 2018 practice guidance lies in the methodology used to develop the recommendations. The 2018 practice guidance is derived through an expert-driven assessment of the literature, whereas the 2009 guidelines were based on a systematic review. The new practice guidance also introduces the concept of risk stratification and the evaluation of biochemical response to treatment. The diagnosis of PBC requires two out of three criteria: biochemical evidence of cholestasis, presence of antimicrobial antibodies, and histological evidence of cholangitis. Liver biopsy is not necessary for diagnosis in certain cases. The first-line therapy for PBC remains ursodeoxycholic acid (UDCA), with a recommended dose of 13-15mg/kg/day. Obeticholic acid (OCA) is the FDA-approved second-line therapy for patients who do not respond to or are intolerant to UDCA. Other off-label therapies that can be considered include fibrates and budesonide. The guidance also discusses the management of symptoms such as fatigue, pruritus, abdominal pain, and dry eyes/mouth. Regular monitoring of liver function, thyroid-stimulating hormone, bone densitometry, and screening for varices is recommended. The guidance also provides recommendations for managing hyperlipidemia and osteoporosis. It is important to note that treatment decisions should be individualized based on the specific needs of each patient.

Asset Caption

Presenters: Cynthia Levy, MD and Marlyn Mayo, MD

Keywords

PBC Practice Guidance

risk stratification

biochemical response

ursodeoxycholic acid

Obeticholic acid

off-label therapies

management of symptoms

regular monitoring

treatment decisions