Risk Stratification in Primary Biliary Cholangitis

Primary Biliary Cholangitis (PBC) is a chronic cholestatic liver disease with a heterogeneous presentation, symptomatology, disease progression, and response to therapy. The current risk stratification assessment, aimed at identifying patients with a higher risk of disease progression, encompasses an in-depth analysis of demographic data, clinical and laboratory findings, antibody profiles, and the evaluation of liver fibrosis using both invasive and noninvasive techniques. Treatment response scores after one year of therapy remain to date a major factor influencing the prognosis of PBC patients. While the initial therapeutic approach with ursodeoxycholic acid (UDCA) is universally applied, new second-line treatment options have recently emerged, with many others under investigation. Consequently, the prevailing one-size-fits-all approach is poised to be supplanted by tailored strategies, ensuring high-risk patients receive the most appropriate treatment regimen from diagnosis. This will require the development of a risk prediction model to assess, at the time of diagnosis, the course, outcome, and response to first and additional treatments of PBC patients. This manuscript provides a comprehensive overview of the current and emerging tools used for risk stratification in PBC and speculates on how these developments might shape the disease landscape in the near future.

Automated summary

Primary Biliary Cholangitis (PBC) is a liver disease with a varied presentation, progression, and response to treatment. Current risk assessment relies on analyzing demographic data, clinical findings, antibody profiles, and liver fibrosis evaluation to identify patients at higher risk of disease progression. The response to therapy after one year remains a significant factor influencing the prognosis of PBC patients. Tailored treatment strategies are emerging to replace the one-size-fits-all approach, requiring the development of risk prediction models to assess patients' course, outcome, and response to treatment at the time of diagnosis. This review provides an overview of current and emerging risk stratification tools and speculates on their potential impact on PBC management.