Efficacy, symptoms, and safety of second-line PBC therapies: a network meta-analysis.

What was studied

This network meta-analysis compared second-line drugs for primary biliary cholangitis. Patients had an inadequate response to ursodeoxycholic acid. Drugs included PPAR agonists, an FXR agonist and an IBAT inhibitor. Searches ran up to early 2026. Trials lasted 12-52 weeks. It looked at lab response, itch and safety. 1,540 patients were included. Drugs were ranked using P-scores.

What they found

Bezafibrate ranked highest for the POISE lab response. Seladelpar 10 mg ranked highest for full ALP normalization. Seladelpar and linerixibat eased itch. Obeticholic acid made itch worse. Seladelpar 10 mg had the most favorable balance of gain and risk. Obeticholic acid had top tolerability. But it lacked ALP normalization and itch relief.

What it means for patients

The authors say care is shifting toward individual plans. Bezafibrate was strongest for POISE criteria. Seladelpar 10 mg gave the most advantageous balance. It gave deep lab remission, itch relief and a favorable safety profile.

Why it is not certain yet

Trials were short, at 12-52 weeks. The rankings rest on indirect comparisons. Some estimates had very wide intervals. The abstract names no other limits.

Source

Efficacy, symptoms, and safety of second-line PBC therapies: a network meta-analysis.

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