{"doi":"10.1111/liv.16222","title":"Second‐Line Treatment for Patients With Primary Biliary Cholangitis: A Systematic Review With Network Meta‐Analysis","abstract":"BACKGROUND & AIMS: Approximately 40% of patients with Primary Biliary Cholangitis (PBC) show incomplete response to ursodeoxycholic acid, thus needing second-line treatment to prevent disease progression. As no head-to-head comparison study is available, we used a network meta-analysis (NMA) to compare efficacy and safety of available second-line therapies. METHODS: We performed a systematic literature review including randomised, placebo-controlled trials of patients with PBC and incomplete response, or intolerance, to ursodeoxycholic acid, and compared relative risks (RRs) for primary (biochemical response at 52-week) and secondary outcomes [incidence of new-onset pruritus and serious adverse events (SAEs)]. RESULTS: The NMA included three studies, each testing obeticholic acid (OCA), seladelpar or elafibranor versus placebo (active therapy/placebo: 379/191 patients). All treatments significantly increased the RR for biochemical response with an advantage of elafibranor versus seladelpar (RR: 4.37, 95% CI: 1.01-18.87). OCA 5-10 mg/10 mg was associated with a higher risk of new-onset pruritus compared to placebo (RR: 1.43; 95% CI: 1.09-1.88/RR: 1.79; 95% CI: 1.37-2.33), while seladelpar decreased this risk (RR: 0.30; 95% CI: 0.12-0.80). Compared to placebo, OCA 5-10 mg/10 mg was associated with an increased risk of SAE (RR: 3.82; 95% CI: 1.46-10.02/RR 2.67; 95% CI: 1.00-7.08). CONCLUSIONS: Among second line therapies for patients with PBC, elafibranor is slightly more effective in obtaining biochemical response than seladelpar that, on the other hand, is the only drug associated with a lower incidence of pruritus. While of similar efficacy, OCA was associated with increased pruritus and SAEs. These findings may help personalise second-line treatment in patients with PBC.","journal":"Liver International","year":2024,"id":434538,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":13,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9568,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":842405,"name":"Andrea Pasta","orcid":"0000-0003-1791-4506","position":1,"is_corresponding":false},{"id":1241328,"name":"Francesco Calabrese","orcid":"0009-0008-4706-1499","position":2,"is_corresponding":false},{"id":1241329,"name":"Sara Labanca","orcid":"0000-0001-8537-4711","position":3,"is_corresponding":false},{"id":1241330,"name":"Simona Marenco","orcid":"0000-0002-6752-1551","position":4,"is_corresponding":false},{"id":1241331,"name":"Giulia Pieri","orcid":"0000-0002-1502-916X","position":5,"is_corresponding":false},{"id":852604,"name":"Maria Corina Plaz Torres","orcid":"0000-0003-4257-1058","position":6,"is_corresponding":false},{"id":97337,"name":"Mario Strazzabosco","orcid":"0000-0002-1995-6331","position":7,"is_corresponding":false},{"id":625141,"name":"Edoardo G. Giannini","orcid":"0000-0001-8526-837X","position":0,"is_corresponding":true}],"reference_count":32,"raw_metadata":null,"created_at":"2026-07-19T01:59:58.582186Z","pmid":"39720853","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}