Need for Earlier Evaluation of UDCA Response, Need for Earlier Consideration of Second-Line Therapy

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In this episode of the CLDF/GHAPP PBC Podcast Series, Dr. Kimberly Brown, Professor of Medicine at Henry Ford Hospital in Detroit, Michigan, and Dr. Sonal Kumar, Assistant Professor and Director of Clinical Hepatology at Weill Cornell Medicine in New York City, explore how clinical practice is evolving when it comes to earlier intervention and individualized treatment in Primary Biliary Cholangitis (PBC). With second-line therapies now available, the discussion centers on when to move beyond ursodiol (UDCA), how to evaluate response using markers like alkaline phosphatase and bilirubin, and why the traditional 12-month assessment window is shifting earlier to 3 or 6 months. Drs. Brown and Kumar share insights from their respective practices, emphasizing a more proactive and personalized approach to managing PBC patients—especially those with advanced fibrosis at baseline, men, and patients from underrepresented populations who may be at higher risk for progression. They also discuss the importance of treatment normalization, monitoring response trends over time, and using early biochemical signals to determine the need for second-line therapies. This episode provides real-world perspectives from hepatology leaders in two major academic centers, highlighting the importance of shifting away from “wait-and-see” models and toward timely, aggressive care that optimizes long-term outcomes in PBC.