An insight into primary biliary cholangitis and its recent advances in treatment: semi-synthetic analogs to combat ursodeoxycholic-acid resistance

ABSTRACT

Introduction

Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease which on progression causes cirrhosis; various studies also suggested that several diseases can co-exist in patients. In existing depiction of disease PBC, apart from entire use of ursodeoxycholic acid (UDCA), several patients need to step forward to liver-transplantation or death due to resistance or non-responder with UDCA monotherapy.

Areas covered

To overcome this non-respondent treatment, novel bile acid semi-synthetic analogs have been identified which shows their potency against for farnesoid X receptor and transmembrane G protein-coupled receptor-5 which are identified as target for many developing analogs which have desirable pharmacokinetic profiles.

Expert opinion

A range of studies suggests that adding semisynthetic analogs in therapeutic regime improves liver biochemistries in patients with suboptimal response to UDCA. Thus, the aspire of this review is to abridge and compare therapeutic value and current markets affirm of various bile acids semi-synthetic analogs which certainly are having promising effects in PBC monotherapy or in pooled treatment with UDCA for PBC.

KEYWORDS:

• Primary biliary cholangitis
• UDCA
• non-responder
• cirrhosis
• semi-synthetic analogs

Article highlights

• The incidence of liver diseases is increasing worldwide in which PBC disease is one of the leading outcomes, especially in females. So, this article provides an overview of important prospects of primary biliary cholangitis.

• PBC occurrence is strongly associated with gender as well as the age of patient.

• The world widely available treatment for PBC is ursodeoxycholic acid (UDCA) therapy. However, several patients need to step forward to liver-transplantation or further treatment and even become the cause of death of patients, due to resistance or non-responder with UDCA monotherapy.

• To overcome this non-respondent treatment, novel bile acid semi-synthetic analogs have been identified and consider as a potential option.

• The semi-synthetic analogs show very promising effects in monotherapy or in the combination treatment with UDCA.

• This review is to abridge and compare therapeutic value and current markets affirm of various bile acids semi-synthetic analogs.

Acknowledgments

The authors would like to thank Dr. Salahuddin (head of the department of Pharmaceutical chemistry, NIET) and management of NIET Pharmacy Institute, Greater Noida-201306, for providing all necessary technical supports and motivating us at every stage.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership, or options, expert testimony, grants, or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.