Primary biliary cholangitis is a chronic liver disease, which means it lasts a long time and tends to gradually get worse — especially without treatment. Although there’s currently no cure for PBC (formerly called primary biliary cirrhosis), treatment can help slow the disease’s progression and protect your liver from long-term damage.

Treatment Options for PBC

Doctors think PBC is an autoimmune disease, a type of condition in which the body’s immune system — which normally fights germs — mistakenly attacks healthy cells. In PBC, your immune system attacks the small bile ducts in your liver and creates inflammation. Over time, inflammation kills off healthy cells. Your liver tries to heal itself through fibrosis (making scar tissue). This tissue narrows the bile ducts and causes bile to build up.

Bile is a fluid that flows through the bile ducts into the small intestine. It’s responsible for breaking down fats and helping your body absorb vitamins and process cholesterol. Damaged bile ducts can’t carry bile to the digestive system, causing buildup in the liver and liver damage. Eventually, the scar tissue interferes with liver function and can lead to permanent damage, known as cirrhosis.

According to the American Liver Foundation, UDCA is effective in over half of people with PBC.

Medication can help bile flow better, reduce swelling in the liver, and help with PBC symptoms.

Ursodeoxycholic Acid

Ursodeoxycholic acid (UDCA) is the first treatment doctors prescribe for PBC. This medication is also known as ursodiol (sold under several brand names). UDCA helps move bile through the liver into the small intestine.

According to the American Liver Foundation, UDCA is effective in more than half of people with PBC. It’s important to start taking it early in PBC because UDCA can help slow down how quickly the disease gets worse. UDCA likely won’t help with common symptoms such as tiredness and itchiness. However, this treatment can help reduce liver scarring and may prevent the need for (or delay) a liver transplant.

About 5 percent to 10 percent of people with PBC can’t tolerate UDCA. Weight gain, hair loss, and diarrhea are possible side effects. Doctors can tell if the drug is working by measuring alkaline phosphatase (ALP) and bilirubin levels. If these blood test levels don’t return to normal, the treatment isn’t working. At that point, it’s time to try something else.

For people whose symptoms don’t improve with UDCA, another medicine is added. Options for a second medication include:

• Elafibranor
• Seladelpar
• Fibrates
• Liver transplant
• Investigational treatments

Obeticholic acid (Ocaliva) was approved for treating PBC in 2016. However, it was withdrawn from the market by its manufacturer in Septem 2025, at the request of the U.S. Food and Drug Administration (FDA). This medication was used with UDCA or by itself if someone couldn’t take UDCA. Like UDCA, obeticholic acid aimed to slow liver fibrosis or scarring while improving liver function. Since it was pulled from the market, obeticholic acid is no longer available as a PBC treatment option.

Elafibranor

The FDA approved elafibranor (Iqirvo) in 2024 to treat PBC. This medication works by targeting pathways that cause liver inflammation. It belongs to a group of drugs called peroxisome proliferator-activated receptor (PPAR) agonists. In studies, elafibranor helped lower ALP levels (a marker of liver damage) and helped keep the liver working well.

Elafibranor is taken once a day by mouth. Healthcare providers may prescribe elafibranor along with UDCA for people who aren’t getting results from UDCA only. Elafibranor may also be used alone for people who can’t tolerate UDCA.

Common side effects of elafibranor include mild to moderate gastrointestinal issues. Some people have weight changes, abdominal pain, nausea, and diarrhea. Always tell your healthcare provider if you experience any side effects of medication.

Seladelpar

Another PBC treatment approved in 2024 is seladelpar (Livdelzi), a type of medication known as a PPAR agonist. Seladelpar may be combined with UDCA or prescribed by itself.

Clinical trials have found several benefits of seladelpar for PBC management, including:

• Less reported fatigue, sleep problems, and itching
• Lower alkaline phosphatase levels
• Reduced bilirubin levels

You can take seladelpar with or without food. However, it needs to be taken four hours before or after bile acid sequestrants — medicines that help lower cholesterol and remove bile acids from the body and may interfere with absorption of seladelpar. Some of the more common side effects include bloating, feeling full, headache, and nausea.

Fibrates

Fibrates are a type of medicine usually used to treat high cholesterol. They also work as PPAR-alpha agonists, which means they help turn on proteins that control fats and lower inflammation in the body.

If UDCA doesn’t work well for you, your doctor may suggest trying fenofibrate (sold under several brand names).

Researchers aren’t quite sure why fenofibrate helps treat PBC. Some studies suggest that fibrates help reduce bile acid production and target liver inflammation. Taking fibrates with UDCA may also reduce skin itching in PBC.

Common side effects of fibrates include sneezing, a runny nose, and abnormal lab test results. Call your healthcare provider right away if you experience sharp stomach pain, muscle pain, jaundice (yellowing of the eyes and skin), fever, chest pain, or other severe symptoms.

Liver Transplant

Because PBC is a progressive disease — it gets worse over time — medications may eventually stop working, resulting in cirrhosis and liver failure. The best way to treat liver cirrhosis and failure is with a liver transplant. This surgery replaces the diseased liver with a healthy liver from a donor.

The best way to treat liver failure is with a liver transplant. This surgery replaces the diseased liver with healthy tissue from a donor.

Most people who receive a liver transplant have a good prognosis (outlook) with PBC. However, there’s a chance that PBC will return. Work closely with your doctors and stick to your treatment plan to avoid this complication.

Investigational Treatments

Researchers are studying other treatments for their potential to help people with PBC. One medication being studied is budesonide. This corticosteroid (steroid) may be used to treat PBC in people without liver cirrhosis who did not benefit from other treatments. Budesonide can have many side effects, such as:

• Swelling
• High blood pressure
• Mood swings
• Weight gain
• Eye problems
• Osteoporosis (weaker bones)

If your healthcare provider thinks you’ll benefit from corticosteroids, they’ll monitor for side effects and make changes as needed. According to Mayo Clinic, more research needs to be done before budesonide is recommended for treating PBC.

Treating Symptoms of PBC

Liver damage from PBC can affect many other parts of the body. Many people experience itchy skin or symptoms of related autoimmune diseases. Along with PBC treatments, doctors may also prescribe medications to help manage associated symptoms, like itchy skin or dry eyes.

Treatments for Itchy Skin

Intensely itchy skin is a common and uncomfortable symptom of PBC. Over-the-counter antihistamines or allergy medications, available at drugstores or grocery stores, block histamines — the chemicals responsible for causing itching during an allergic reaction. Diphenhydramine or loratadine may help, especially if itchy skin keeps you awake at night. Some of these medications may cause drowsiness.

Your doctor may also prescribe the following medications for itchiness:

• Cholestyramine — A medication typically used to treat high cholesterol
• Opioid antagonists (naltrexone, naloxone) — Medications that also act on the brain to stop itching sensations
• Rifampin — An antibiotic that may block itching sensations
• Sertraline hydrochloride — A selective serotonin reuptake inhibitor (SSRI) used to treat itching

These medications come with a wide range of possible side effects. Ask your doctor or pharmacist what to expect. Tell your healthcare provider if you’re experiencing side effects after starting treatment.

Treatments for Dry Mouth and Dry Eyes

PBC can also cause dry eyes and dry mouth. Your doctor may suggest using saliva substitutes, chewing gum, sucking on hard candy, and using artificial tears and eye drops such as pilocarpine to help. These treatments aren’t likely to cause bad side effects, but keeping up with regular eye and dental exams is a good idea.

Treating Complications of PBC

PBC can lead to other health complications like vitamin deficiencies, bone problems, high cholesterol, and cirrhosis. Your doctor can help you manage these complications with medications and lifestyle changes.

Without enough bile in the digestive system, your body can’t properly absorb fat-soluble vitamins (vitamins A, D, E, and K). Doctors may prescribe vitamin supplements to help boost vitamin levels, like vitamin D and calcium for strong bones and vitamin K for blood clotting. Your physician may also recommend checking for low bone mass with a bone scan.

High cholesterol and xanthomas (deposits of cholesterol in the skin) can also develop in people with PBC. This is treated with fibrates and other lipid-lowering agents.

When a lot of scar tissue builds up in the liver as PBC gets worse, it can lead to cirrhosis. Complications of cirrhosis include:

• Variceal bleeding (bleeding from large veins in the esophagus)
• Ascites (fluid buildup in the abdomen)
• Encephalopathy (confusion or trouble thinking clearly, caused by toxin buildup)
• Hepatocellular carcinoma (liver cancer)

Your doctor will closely monitor you for complications of cirrhosis and prescribe specific medications for each complication as needed.

There’s a lot to think about when living with PBC. You may need regular checkups and tests to see how your PBC is doing and to watch for other health problems. Staying in touch with your healthcare team can help you find a treatment plan that’s right for you.

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On myPBCteam, people share their experiences with primary biliary cholangitis, get advice, and find support from others who understand.

What PBC treatments have you tried, and did you have any side effects? Let others know in the comments below.