Not Responding to UDCA in the First Few Months, Need to Move on to Second-Line Therapy

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Welcome to the CLDF/GHAPP PBC Podcast Series. In this episode, Dr. Kimberly Brown, Associate Medical Director at Henry Ford Hospital in Detroit, Michigan, is joined by Dr. Sonal Kumar, Assistant Professor of Medicine and Director of Clinical Hepatology at Weill Cornell in New York City. Together, they explore the real-world management of Primary Biliary Cholangitis (PBC), focusing on optimizing first-line therapy with ursodiol (UDCA) and the shift toward earlier initiation of second-line therapies. The conversation highlights evidence-based dosing strategies, side effects commonly seen with ursodiol—such as GI discomfort and hair loss—and the variation in tolerability among different generic formulations. Drs. Brown and Kumar also discuss how clinicians are rethinking the timing for evaluating response, moving from the traditional 12-month window to as early as 3 to 6 months, based on changes in alkaline phosphatase and bilirubin levels. They share how they prepare patients for second-line therapy, set expectations, and use lab trends and annual FibroScan assessments to demonstrate treatment success—even when symptoms may not noticeably improve. This episode provides expert insights from two leading hepatologists in Detroit and New York City, offering practical, patient-centered strategies for improving long-term outcomes in PBC management.