Recent research has shifted the optimal management of primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC) and other cholestatic and autoimmune liver diseases. Several experts will explore this new research and how it affects the field during an Advances for Practitioners session on Monday.
“The purpose of the Advances for Practitioners session in general is to allow attendees to integrate ongoing and recently published research studies, as well as expert opinion, into their clinical practice,” said Cynthia Levy, MD, FAASLD, a co-chair of the session. “This year’s program will highlight recent key studies in the field of cholestatic and autoimmune liver diseases so this can be translated into immediate optimization of patient care.”
Dr. Levy is an Associate Professor of Medicine at the University of Miami in Florida, and the director of the University’s transplant hepatology fellowship program. She is co-chairing the session along with Elizabeth J. Carey, MD, FAASLD, who is Associate Professor of Medicine at the Mayo Clinic in Phoenix, Ariz.
The session will begin with discussions of PBC and PSC. Christopher L. Bowlus, MD, FAASLD, of the University of California, Davis, will discuss some of the advances in management of PBC. “We will review data on new therapies for the treatment of primary biliary cholangitis and discuss the role of risk stratification in the management of this disease, focusing on obeticholic acid,” Dr. Levy said. The agent was approved for treatment of PBC along with ursodeoxycholic acid (UDCA) in May 2016; the U.S. Food and Drug Administration issued a safety announcement regarding the drug in September of this year, noting that it is being incorrectly dosed and can result in serious liver injury or death.
“This session is a great opportunity to educate providers on the appropriate use of obeticholic acid,” Dr. Levy said. The discussion of PBC treatments will briefly include some agents still under development.
Christoph Schramm, MD, of University Medical Center Hamburg-Eppendorf in Germany, will discuss strategies for diagnosis and surveillance of cholangiocarcinoma in PSC. “Even though cholangiocarcinoma is recognized as a major complication of PSC, an ideal screening tool is not yet available, and therefore there is no consensus on a surveillance strategy,” Dr. Levy said. “Recent studies evaluating new biomarkers and surveillance strategies in PSC will be reviewed to determine their usefulness and applicability.”
In the final talk of the session, John M. Vierling, MD, FAASLD, of Baylor College of Medicine in Houston, will discuss a proposed new treatment algorithm for the management of autoimmune hepatitis. “A subset of patients with autoimmune hepatitis fail to respond to standard immunosuppression protocols with combination of azathioprine and steroids, and another significant subset is intolerant to azathioprine,” Dr. Levy said. Dr. Vierling will examine the evidence underlying the use of specific second-line therapies in these patients and base the new treatment algorithm around this evidence.
“We hope this will directly affect patient care, and perhaps even facilitate interaction with payers, who frequently do not recognize these second-line therapies for autoimmune hepatitis, and deny coverage,” Dr. Levy said.
The session will conclude with a panel discussion.