From the Research
Plasma exchange therapy is not a standard treatment approach for primary sclerosing cholangitis (PSC) and its efficacy remains limited and inconclusive. The most recent and highest quality study on PSC, published in 2025 1, does not mention plasma exchange therapy as a treatment option, highlighting the lack of evidence for its effectiveness.
Current Treatment Options
The current primary medical therapy for PSC is ursodeoxycholic acid (UDCA) at 13-15 mg/kg/day, although its benefit is modest 1, 2. Other treatment options, such as endoscopic therapy of biliary strictures, management of complications of chronic cholestasis, and liver transplantation, are also available 3, 2.
Experimental Approaches
For patients considering plasma exchange, it should be viewed as an experimental approach best pursued within clinical trials or specialized centers with experience in both PSC management and apheresis procedures 4, 5. The therapy carries risks including bleeding, hypotension, allergic reactions, and infection.
Future Directions
Several novel therapeutic strategies are in various stages of development, including apical sodium-dependent bile acid transporter and ileal bile acid transporter inhibitors, integrin inhibitors, peroxisome proliferator-activated receptor agonists, and nor-ursodeoxycholic acid 1, 4. Manipulation of the gut microbiome, including fecal microbiota transplantation, is also being explored as a potential treatment option 1, 4.
Key Considerations
When considering treatment options for PSC, it is essential to prioritize morbidity, mortality, and quality of life as the primary outcomes. The lack of effective medical therapy for PSC highlights the need for further research and development of novel therapeutic strategies. Patients with PSC should be closely monitored for development of cholangiocarcinoma and other complications, and referred for liver transplantation when necessary 3, 2.