Building a Sense of Urgency for PBC Patient Evaluation/Monitoring

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In this episode of the CLDF GHAPP PBC Podcast Series, Dr. Kimberly Brown joins Dr. Steven Flamm for an important discussion on building a sense of urgency around evaluating and monitoring patients with Primary Biliary Cholangitis (PBC). Together, they explore how clinical practice has evolved to recognize the variability and unpredictability of PBC progression, emphasizing the importance of early assessment, frequent follow-up, and timely adjustments to therapy. Drawing on new guidance from the CLDF and their own experience at major transplant centers, Drs. Brown and Flamm stress the importance of tracking alkaline phosphatase and bilirubin levels as key indicators of disease activity and risk. They highlight that certain high-risk populations—such as men, patients of color, and younger individuals—require even closer monitoring due to more aggressive disease trajectories. The conversation also addresses the need to reassess patients within three to six months of initiating therapy, the clinical implications of inadequate response to first-line treatment with ursodiol (URSO), and when to consider second-line options. Additionally, the episode explores the intersection of PBC and other liver conditions like MASH, underscoring the importance of a comprehensive approach in complex patients. This discussion, rooted in real-world hepatology practice in the Midwest, offers practical, timely guidance for clinicians nationwide who are striving to deliver optimal care for patients with PBC.