The future of primary biliary cholangitis treatment

Seladelpar

Seladelpar has shown promise in early trials as a treatment for PBC. It reduces the amount of bile acids your body makes. In PBC, bile acids are the cause of liver damage and of symptoms such as itching. Seladelpar is also anti-inflammatory and may help to stop scars (fibrosis) forming in the liver. 

This type of medicine is called a PPAR Agonist (which stands for Peroxisome Proliferator Activated Receptor Agonist). This is the same type as elfibranor, which was approved by NICE in 2024 and by the SMC in 2025. Read more about elafibranor on our PBC treatments page.

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Fenofibrate

This is a type of drug called a fibrate. It’s usually used to treat high cholesterol. But in PBC, it works in a similar way to Seladelpar and Elafibranor as it also reduces the production of bile acids. It may also damp down the body’s immune response.

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Other trial treatments

There are other areas of research, looking into treating PBC with steroids, drugs to suppress the immune system, and anti-viral medicines. Some of these trials compare the new treatment to the current standard treatment.  There are also trials looking into reducing the dose of standard treatment in patients whose PBC is stable.

As with the medicines above, until these have been shown to work better than standard treatment with UDCA, they won’t be licensed for use outside clinical trials.

As a patient with PBC you may be invited to take part in clinical trials. These are voluntary – you don’t have to agree to take part and you can change your mind at any time after you’ve agreed. You’ll have lots of information to consider and can talk this through with your doctor. You can take time to decide if it is the right option for you – you don’t have to agree straight away.

Having said all that, PBC is a relatively rare condition so it is very helpful when patients do take part in clinical trials. Some patients feel that by doing this, they are helping people with PBC in the future.

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Research into treating and managing symptoms

As well as research into new treatments, there are also studies looking at better ways of controlling itching or managing fatigue.

Two medicines that are being investigated for itching are Bezafibrate and Linerixibat. Bezafibrate has been tested as a PBC treatment and found to be better at reducing itching than similar drugs. Linerixibat reduces the amount of bile salts circulating in your blood, which are the cause of itching. It is currently in world-wide clinical trials, including in the UK.

There are a number of different approaches in trial for fatigue related to PBC. These include:

• high dose vitamin B1 (thiamine) tablets
• exercise programmes
• mindfulness
• hypnosis combined with education on managing fatigue
• an online wellness course with yoga, meditation and lifestyle advice

Some of these are standard approaches for managing fatigue in general. The research may help to show which are particularly helpful in PBC. There is information in the page on living with PBC about ways to try and manage fatigue.

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 living with PBC

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Published: October 2024 and amended in November 2024 to update our information on elafibranor