REVIEW article
Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders: Autoinflammatory Disorders
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1698833
This article is part of the Research TopicLiver Diseases – From Pathophysiology to New Treatment OptionsView all 8 articles
"Primary biliary cholangitis. Treatment options in 2025. A narrative review."
Provisionally accepted
Maria Angelara1Klairi Papachristou2
Margarita Papatheodoridi3
Narjes Nasiri Ansari4
Dimitrios S Karagiannakis5
Theodoros Androutsakos2*- 1First Department of Internal Medicine, Propaedeutic Clinic, "Laiko" Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece, Athens, Greece
- 2Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece, Athens, Greece
- 3Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Athens, Greece, Athens, Greece
- 4Martin-Luther-Universitat Halle-Wittenberg, Halle (Saale), Germany
- 54th Department of Internal Medicine, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece., Athens, Greece
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Primary biliary cholangitis (PBC) is a chronic, cholestatic disease with a female predominance and a long disease duration. The pathogenesis of PBC is still unclear; however, genetic, epigenetic, and environmental factors, alongside immune dysregulation, seem to lead to a dysfunction of the biliary 'bicarbonate umbrella' and increased biliary epithelial cells apoptosis. Ursodeoxycholic acid (UDCA) has been the treatment of choice for PBC since its approval back in 1994; however, a percentage varying from 15-40% of all patients fail to achieve biochemical response or alkaline phosphatase normalization. Obeticholic acid, though promising at first, failed to show benefit after long-term use and was retracted from the market. Two peroxisome proliferator–activated receptor agonists (PPARs) have recently been approved for use in patients with PBC, showing biochemical response in non-responders and improvement of pruritus. However, a substantial percentage of patients fail to achieve serum alkaline phosphatase and bilirubin normalization; as a result, many drugs with different mechanisms of action are in phase 2 or 3 trials. The aim of this review is to present available data regarding PBC treatment and explain the pathogenetic pathway each one targets.
Keywords: Autoimmune liver disease, Primary biliary cholangitis, Elafibranor, FXR agonists, Liver, Obeticholic acid, Peroxisome proliferator–activated receptors, Seladelpar
Received: 04 Sep 2025; Accepted: 14 Oct 2025.
Copyright: © 2025 Angelara, Papachristou, Papatheodoridi, Nasiri Ansari, Karagiannakis and Androutsakos. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Theodoros Androutsakos, t_androutsakos@yahoo.gr
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