Fatigue in Primary Biliary Cholangitis: no Place for Rituximab.

Patients with Primary Biliary Cholangitis (PBC) have experienced major therapeutic progress during the last four decades. An effective first line therapy, ursodeoxycholic acid (UDCA), is available from which all patients, responders as well as 'incomplete' responders, appear to benefit according to newest data. Increasing insight in the mechanisms and sites of action of UDCA has meanwhile been gained. Potential second line treatments are also available when UDCA alone is not effective enough: the farnesoid X receptor (FXR) agonist obeticholic acid, conditionally approved by North American (FDA) and European (EMA) authorities as second line treatment in PBC, or the nonspecific peroxisomal proliferator-associated receptor (PPAR) agonist bezafibrate.