From the Research
Primary biliary cholangitis (PBC) and inflammatory bowel disease (IBD) should be managed with a multidisciplinary approach, prioritizing the treatment of PBC with ursodeoxycholic acid (UDCA) and considering the addition of obeticholic acid or PPAR agonists for inadequate responders, while also addressing IBD with aminosalicylates, corticosteroids, immunomodulators, or biologics as needed, with careful monitoring of medication interactions and liver function 1.
Treatment Approach
- For PBC, the first-line treatment is ursodeoxycholic acid (UDCA) at 13-15 mg/kg/day, which slows disease progression and improves liver biochemistry.
- If patients have an inadequate response to UDCA after 12 months, obeticholic acid (5-10 mg daily) or PPAR agonists can be added to improve surrogate markers of prognosis and reduce the risk of disease progression 1.
- For IBD, treatment depends on disease severity and type (Crohn's disease or ulcerative colitis), with options including:
- Aminosalicylates like mesalamine (2-4.8 g/day) for mild to moderate cases.
- Corticosteroids (prednisone 40-60 mg/day with taper) for more severe cases.
- Immunomodulators (azathioprine 2-2.5 mg/kg/day or 6-mercaptopurine 1-1.5 mg/kg/day) or biologics (infliximab, adalimumab, vedolizumab, or ustekinumab) for refractory cases.
Monitoring and Management
- Regular blood tests to monitor liver enzymes, complete blood counts, and inflammatory markers are essential for both conditions.
- Patients with both conditions should be managed by a multidisciplinary team including gastroenterologists and hepatologists to coordinate care effectively.
- Medication interactions must be carefully monitored, particularly regarding liver function, to minimize the risk of adverse effects and optimize treatment outcomes 2, 1.