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Aug 3, 2023 | 
hcplive.com | Kris V. Kowdley |Steven Flamm |Edward Mena |David Victor III
Kris Kowdley, MD, FACP, FACG, AGAF, FAASLD: We’re comingto the end of this discussion, but I want to talk about unmet needs in PBC [primary biliary cholangitis]. What are some unmet needs? I’m going to have everyone comment, but I’m going to start with you, David. David Victor III, MD: This was a lead-in to say that transplantation for patients with PBC is an unmet need.
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Aug 3, 2023 | 
hcplive.com | Kris V. Kowdley |Steven Flamm |Edward Mena |David Victor III
Kris Kowdley, MD, FACP, FACG, AGAF, FAASLD: There are a lot of new things, like new medications in development. Seladelpar is in a phase 3 trial that’s close to enrollment. Elafibranor is in a phase 3 trial that’s close to enrollment. These are PPAR-Δ and PPAR-⍺-Δ dual agonists. Saroglitazar, which is an PPAR-⍺-γ dual agonist, is also in clinical trials. There’s a fixed-dose combination study that’s ongoing with obeticholic acid and bezafibrate. Sonal, what’s your impression about these trials?
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Jul 27, 2023 | 
hcplive.com | Kris V. Kowdley |Steven Flamm |Edward Mena |David Victor III
Kris Kowdley, MD, FACP, FACG, AGAF, FAASLD: Ed, we have all the trials for second-line treatment that would require the patient to be on a stable dose of ursodiol for a year before you can consider second-line treatment. What is your practice? Do you start the patient on second-line treatment and then wait a year before you decide that they need to have fenofibrate added or something else? Edward Mena, MD: It would depend on the staging of their disease.
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Jul 27, 2023 | 
hcplive.com | Kris V. Kowdley |Steven Flamm |Edward Mena |David Victor III
Kris Kowdley, MD, FACP, FACG, AGAF, FAASLD: Speaking of the stage of the disease, that brings us to an interesting discussion among the PBC [primary biliary cholangitis] circles. This is a hot topic, and Ed, you alluded to this in terms of triple therapy. So, have you used triple therapy? When would you use it? If you haven’t used it, when would you consider using it?
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Jul 20, 2023 | 
hcplive.com | Kris V. Kowdley |Steven Flamm |Edward Mena |David Victor III
Kris Kowdley, MD, FACP, FACG, AGAF, FAASLD: I’m going to switch gears and talk about the long-term, real-world evidence that is now accumulating about the potential efficacy of obeticholic acid as a second-line treatment. We already have data from Japan with bezafibrate, which is not available in the United States but was first introduced for managing PBC [primary biliary cholangitis] as second-line treatment in Japan.
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Jul 20, 2023 | 
hcplive.com | Kris V. Kowdley |Steven Flamm |Edward Mena |David Victor III
Kris Kowdley, MD, FACP, FACG, AGAF, FAASLD: What are the main adverse effects of obeticholic acid and how do we manage them?I will start with you, Sonal. Sonal Kumar, MD, MPH: Pruritus is probably the No. 1 adverse effect that I’m sure we’ve all encountered in our patients. It’s a little tough to manage pruritus in a patient population that already may have baseline pruritus, but I usually start with cholestyramine. Well, first I start with lifestyle changes to really delve into.
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Jul 13, 2023 | 
hcplive.com | Kris V. Kowdley |Steven Flamm |Edward Mena |David Victor III
Edward Mena, MD: We have to use obeticholic acid with caution in patients who have cirrhosis. You really want to look at patients without portal hypertension. Kris Kowdley, MD, FACP, FACG, AGAF, FAASLD: That’s a good point. Can you tell us, David, about how the recommended use of obeticholic acid has changed since 2021, when there was a label update and cautioned use in patients with decompensated liver disease and portal hypertension?
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Jul 13, 2023 | 
hcplive.com | Kris V. Kowdley |Steven Flamm |David Victor III
Kris Kowdley, MD, FACP, FACG, AGAF, FAASLD: I think we’ve made a few important points. I like the fact that you brought up that Urso can be expensive and can be difficult. About 10% of patients, we think, are intolerant to Urso and experience weight gain, hair loss, and other symptoms. For those patients, do we have an option, Steve, in terms of the data with monotherapy with OCA in patients who are intolerant to Urso? Steven Flamm, MD, FAASLD, FACG: That’s a great question, Kris.
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Jul 6, 2023 | 
hcplive.com | Kris V. Kowdley |Steven Flamm |Edward Mena |David Victor III
Kris Kowdley, MD, FACP, FACG, AGAF, FAASLD: How is PBC currently treated? Ed, why don't you kick us off? You alluded to fenofibrate, which is the fibrate that is available in the US for off-label treatment. Second-line obeticholic acid, which is approved as a second-line treatment, also deoxycholic acid. Tell us a little bit about how these drugs may change the natural history of the disease and how they work.
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Jul 6, 2023 | 
hcplive.com | Kris V. Kowdley |Steven Flamm |Edward Mena |David Victor III
Kris Kowdley, MD, FACP, FACG, AGAF, FAASLD: Let's move on and talk about current and emerging treatment options. I'm going to kick this off by talking about how to control symptoms. We want to improve patients’ quality of life while slowing disease progression. We want to reassure the patient, depending on what risk bracket they are in, that they may not be at risk for progression of liver disease or need liver transplantation or liver-related death.
