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Risk Factors for Progression in PBC

CE / CME

Identifying Risk Factors for Disease Progression and Poor Response in PBC: Implications for First-line Therapy

Pharmacists: 0.75 contact hour (0.075 CEUs)

Physicians: maximum of 0.75 AMA PRA Category 1 Credit

Nurse Practitioners/Nurses: 0.75 Nursing contact hour

Released: March 30, 2026

Expiration: March 29, 2027

Activity

Progress
1 2 3
Course Completed

References

  1. American Association for the Study of Liver Diseases. Primary biliary cholangitis. Practice guidelines. aasld.org/practice-guidelines/primary-biliary-cholangitis. Accessed March 26, 2026.
  2. Corpechot C, Chazouillères O, Poupon R. Early primary biliary cirrhosis: biochemical response to treatment and prediction of long-term outcome. J Hepatol. 2011;55:1361-1367.
  3. Hardie C, Green K, Jopson L, et al. Early molecular stratification of high-risk primary biliary cholangitis. EBioMedicine. 2016;14:65-73. 
  4. Levy C, Manns M, Hirschfield G. New treatment paradigms in primary biliary cholangitis. Clin Gastroenterol Hepatol. 2023;21:2076-2087.
  5. Ursodiol [prescribing information]. Madison, NJ: Allergan USA, Inc.; 2023.
  6. Hernández-Pérez M, Riado D, Pena E, et al. The overlap with metabolic dysfunction-associated steatotic liver disease negatively affects outcomes of primary biliary cholangitis. Aliment Pharmacol Ther. 2024;60:613-619.
  7. Zhang W, De D, Mohammed KA, et al. New scoring classification for primary biliary cholangitis-autoimmune hepatitis overlap syndrome. Hepatol Commun. 2018;2:245-253. 
  8. Murillo Perez CF, Harms MH, Lindor KD, et al; GLOBAL PBC Study Group. Goals of treatment for improved survival in primary biliary cholangitis: treatment target should be bilirubin within the normal range and normalization of alkaline phosphatase. Am J Gastroenterol. 2020;115:1066-1074.
  9. Corpechot C, Lemoinne S, Soret PA, et al; Global & ERN Rare-Liver PBC Study Groups. Adequate versus deep response to ursodeoxycholic acid in primary biliary cholangitis: To what extent and under what conditions is normal alkaline phosphatase level associated with complication-free survival gain? Hepatology. 2024;79:39-48.
  10. Murillo Perez CF, Ioannou S, Hassanally I, et al; Global PBC Study Group. Optimizing therapy in primary biliary cholangitis: Alkaline phosphatase at six months identifies one-year non-responders and predicts survival. Liver Int. 2023;43:1497-1506.
  11. Ludwig J, Dickson ER, McDonald GS. Staging of chronic nonsuppurative destructive cholangitis (syndrome of primary biliary cirrhosis). Virchows Arch A Pathol Anat Histol. 1978;379:103-112.
  12. Scheuer P. Primary biliary cirrhosis. Proc R Soc Med. 1967;60:1257-1260.
  13. Purohit T, Cappell MS. Primary biliary cirrhosis: Pathophysiology, clinical presentation and therapy. World J Hepatol. 2015;7:926-941.
  14. Corpechot C, Abenavoli L, Rabahi N, et al. Biochemical response to ursodeoxycholic acid and long-term prognosis in primary biliary cirrhosis. Hepatology. 2008;48:871-877.
  15. Murillo Perez CF, Hirschfield GM, Corpechot C, et al; GLOBAL PBC Study Group. Fibrosis stage is an independent predictor of outcome in primary biliary cholangitis despite biochemical treatment response. Aliment Pharmacol Ther. 2019;50:1127-1136.
  16. Kowdley KV, Bowlus CL, Levy C, et al. Application of the latest advances in evidence-based medicine in primary biliary cholangitis. Am J Gastroenterol. 2023;118:232-242.
  17. Osman KT, Maselli DB, Idilman IS, et al. Liver stiffness measured by either magnetic resonance or transient elastography is associated with liver fibrosis and is an independent predictor of outcomes among patients with primary biliary cholangitis. J Clin Gastroenterol. 2021;55:449-457.
  18. Lammers WJ, van Buuren HR, Hirschfield GM, et al. Levels of alkaline phosphatase and bilirubin are surrogate end points of outcomes of patients with primary biliary cirrhosis: an international follow-up study. Gastroenterology. 2014;147:1338-1349.
  19. Martini F, Balducci D, Mancinelli M, et al. Risk stratification in primary biliary cholangitis. J Clin Med. 2023;12:5713.
  20. Carbone M, Mells GF, Pells G, et al; UK PBC Consortium; Sandford RN, Alexander GJ, Jones DE. Sex and age are determinants of the clinical phenotype of primary biliary cirrhosis and response to ursodeoxycholic acid. Gastroenterology. 2013;144:560-569.e7;quiz e13-4. 
  21. Cheung AC, Lammers WJ, Murillo Perez CF, et al; Global PBC Study Group. Effects of age and sex of response to ursodeoxycholic acid and transplant-free survival in patients with primary biliary cholangitis. Clin Gastroenterol Hepatol. 2019;17:2076-2084.e2. 
  22. Hirschfield GM, Dyson JK, Alexander GJM, et al. The British Society of Gastroenterology/UK-PBC primary biliary cholangitis treatment and management guidelines. Gut. 2018;67(9):1568-1594.
  23. Lam L, Soret PA, Lemoinne S, et al; Global & ERN Rare-Liver PBC Study Groups. Dynamics of Liver Stiffness Measurement and Clinical Course of Primary Biliary Cholangitis. Clin Gastroenterol Hepatol. 2024;22:2432-2441.e2.

 

AI Disclosure
Artificial intelligence (AI) was used to assist with editorial refinement of transcript-derived educational content for this module. The platform used was GPT-5.3 on March 12, 2026. AI assistance was limited to language editing and manuscript organization. All content was reviewed, verified, and finalized by human editors to ensure accuracy and compliance with ACCME Standards for Integrity and Independence in Accredited Continuing Education.