Primary Biliary Cholangitis and Incomplete Response to Ursodeoxycholic Acid Therapy: Who is Guilty and What to Do?

Ursodeoxycholic acid (UDCA) is a first-line drug for the treatment of all patients with primary biliary cholangitis (PBC). The biochemical response to UDCA therapy is recommended to be evaluated 12 months after the start of treatment to determine the patient's response to therapy. In clinical practice, patients who do not respond sufficiently to therapy with UDCA drugs are often observed. It is known that an incomplete response ultimately correlates with the progression of the disease. The article presents the results of our own research, which studied the factors leading to an incomplete response of patients to UDCA therapy. Analysis of possible causes of incomplete response allowed us to identify two groups of factors associated with a suboptimal response to treatment of UDCA, which were conditionally divided into modifiable and unmodifiable. Significant prognostic factors of insufficient/incomplete response to therapy were identified, as well as categories of "difficult" patients with unmodifiable incomplete response factors. The results obtained make it possible to personalize approaches to the therapy of patients with PBC, reduce the risks of their incomplete response and optimize treatment