VIDEO: Quality of life a key consideration in PBC treatment

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I'm lucky. I'm a clinician who looks after lots of patients with PBC. The Autoimmune and Rare Liver Disease Program that I direct at Toronto General Hospital in Canada is very large. What that really allows me to do is individualize the care of my patients with PBC. I focus really heavily on making a clear diagnosis, understanding an individual's risk, and listening to the symptom burden that any individual has. I then work with the patient to say, "What am I gonna do to make your test the best they can be, and to improve your quality of life in the most effective way, which fits for your risk, your stage, and your quality of life?"

So I start out with the premise that it's intuitive to aim for normal tests and normal quality of life, and then as I work through that pathway, I say to the patient, "Let's start off with the first-line therapy, ursodeoxycholic acid, bile acid pool modification. Let's then look at six to 12 months and see how you are doing from a biochemical perspective, a risk perspective, and a symptom perspective." And then, based on their stage, do they have cirrhosis and portal hypertension? Do they have early stage disease, but they are itchy? Is their alk phos still elevated, but they're young, and et cetera?

I then will add in second line therapies with the goal of normalizing their tests, and normalizing their symptoms. What this then means is that I have a flexible toolbox that I use, but which takes into account what the patient really needs. And with agents such as obeticholic acid, such as seladelpar, such as elafibranor, such as potentially, alinarixiba about in the future, and other drugs in the development stage, we really do have a much better grasp on managing PBC in an individualized way, and in a risk-guided, target-oriented manner.