Second-line treatment of primary biliary cholangitis: To whom, which molecule, and when

doi:10.4254/wjh.121491

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World Journal of Hepatology

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1948-5182

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World J Hepatol. Aug 27, 2026; 18(8): 121491
Published online Aug 27, 2026. doi: 10.4254/wjh.121491

Table 2 Overview of peroxisome proliferator-activated receptor agonists used in the treatment of primary biliary cholangitis

Name of PPAR agonist	Fibrate/non-fibrate	Isotypes of PPAR	Status of regulatory approval	Clinical results
Elafibranor	Non-fibrate	PPAR-α and PPAR-β/δ	Approved	Improvement of cholestasis
				Biochemical response and ALP normalization
				Reduction of pruritus
				Improvement of fatigue and sleep disturbance
Seladelpar	Non-fibrate	PPAR-β/δ	Approved	Improvement of cholestasis
				Biochemical response
				ALP normalization
				Reduction of pruritus
				Improvement of fatigue and sleep disturbance
Saroglitazar	Non-fibrate	PPAR-α and PPAR-γ	Phase 3 study complete	Improvement of cholestasis
Saroglitazar	Non-fibrate	PPAR-α and PPAR-γ	Phase 3 study complete	Biochemical response and ALP decrease
Bezafibrate	Fibrate	PPAR-α, PPAR-γ and PPAR-β/δ	Off-label	Improvement of cholestasis
				Biochemical response and ALP normalization
				Reduction of pruritus
Fenofibrate	Fibrate	PPAR-α	Off-label	Improvement of cholestasis
				Biochemical response and ALP normalization
				Reduction of pruritus

ALP: Alkaline phosphatase; PPAR: Peroxisome proliferator-activated receptor.

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Citation: Drazilova S, Jarcuska P, Koky T, Harhovsky M, Komarova S, Vasil J, Janicko M. Second-line treatment of primary biliary cholangitis: To whom, which molecule, and when. World J Hepatol 2026; 18(8): 121491
URL: https://www.wjgnet.com/1948-5182/full/v18/i8/121491.htm
DOI: https://dx.doi.org/10.4254/wjh.121491

Drazilova S, Jarcuska P, Koky T, Harhovsky M, Komarova S, Vasil J, Janicko M. Second-line treatment of primary biliary cholangitis: To whom, which molecule, and when. World J Hepatol 2026; 18(8): 121491 [DOI: 10.4254/wjh.121491]

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