Cholestatic liver diseases: modern therapeutics.

IF 3.8 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Expert Review of Gastroenterology & Hepatology Pub Date : 2025-04-01 Epub Date: 2025-03-02 DOI:10.1080/17474124.2025.2473490

Bridgette B McNally, Elizabeth J Carey

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引用次数: 0

Abstract

Introduction: Cholestatic liver disease encompasses a broad group of disorders related to impaired normal bile formation, secretion, or excretion. These diseases present with symptoms of fatigue, jaundice, pruritus, and biochemical changes.

Areas covered: We focus on updates in the management of autoimmune cholestatic liver disease. The mainstay therapy in PBC is UDCA (ursodeoxycholic acid), but OCA (obeticholic acid) can be considered if suboptimal response or intolerance. Fibrates have shown some promising effects in PBC patients who have not responded to or are intolerant of UDCA and/or OCA; however, they are not FDA approved. Peroxisome Proliferator-Activated Receptor Agonists (PPARs) have emerged as a promising new class of oral agents in PBC. Also, Ileal Bile Acid Transporter (IBAT) inhibitors are being investigated for the treatment of pruritus related to PBC. There are no available treatments for PSC; however, there have been previous investigations into many agents. There are ongoing clinical trials investigating the role of various antibiotics, PPARs, and immunomodulators for the treatment of PSC.

Expert opinion: Ongoing investigations into the treatment of both PBC and PSC are essential. We anticipate that alternative management strategies for PBC and PSC will continue to arise in the next 5-10 years.

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胆汁淤积性肝病：现代疗法。

胆汁淤积性肝病包括与正常胆汁形成、分泌或排泄受损相关的一系列疾病。这些疾病表现为疲劳、黄疸、瘙痒和生化变化。涵盖领域：我们关注自身免疫性胆汁淤积性肝病管理的最新进展。PBC的主要治疗是UDCA（熊去氧胆酸），但如果反应不佳或不耐受，可以考虑OCA（奥贝胆酸）。贝特类在对UDCA和/或OCA无反应或不耐受的PBC患者中显示出一些有希望的效果；然而，它们没有得到FDA的批准。过氧化物酶体增殖物激活受体激动剂（PPARs）已成为一类有前途的新型口服PBC药物。此外，回肠胆汁酸转运蛋白（IBAT）抑制剂正在研究用于治疗PBC相关瘙痒。目前尚无治疗PSC的方法；然而，之前已经对许多代理商进行了调查。目前正在进行临床试验，研究各种抗生素、PPARs和免疫调节剂在治疗PSC中的作用。专家意见：对PBC和PSC的治疗进行持续调查是必不可少的。作者预计，在未来5-10年内，PBC和PSC的替代管理策略将继续出现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Review of Gastroenterology & Hepatology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

6.80

自引率

2.60%

发文量

审稿时长

6-12 weeks

期刊介绍： The enormous health and economic burden of gastrointestinal disease worldwide warrants a sharp focus on the etiology, epidemiology, prevention, diagnosis, treatment and development of new therapies. By the end of the last century we had seen enormous advances, both in technologies to visualize disease and in curative therapies in areas such as gastric ulcer, with the advent first of the H2-antagonists and then the proton pump inhibitors - clear examples of how advances in medicine can massively benefit the patient. Nevertheless, specialists face ongoing challenges from a wide array of diseases of diverse etiology.