Ursodeoxycholic acid at about 13–15 mg/kg/day is first-line treatment for primary biliary cholangitis. Response is judged after about 12 months, mainly on alkaline phosphatase and bilirubin.
Patients whose alkaline phosphatase stays raised, or whose bilirubin is rising, have an inadequate response and a worse prognosis; they should be considered for second-line therapy. Check the dose is weight-appropriate and that the patient is taking it before labelling a non-response.
- Dose UDCA at about 13–15 mg/kg/day
- Reassess alkaline phosphatase and bilirubin after about 12 months
- Confirm dose and adherence before calling it inadequate response
- Refer inadequate responders for second-line treatment
Why it matters
Inadequate response is common and often goes unrecognised for years.
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