Sunday Spotlight 🌟: A multi-part discussion, filmed immediately following the seladelpar (Livdelzi; Gilead Sciences) decision, examined recent advances in the management of primary biliary cholangitis (PBC). The series featured expert perspectives from Nancy Reau, Palak Trivedi, and Gideon Hirschfield discussing these evolutions in PBC care and their implications for disease management. Watch the 6-part series here: https://lnkd.in/ehAH6buj #Hepatology
Transcript
Thanks, Gideon. You did allude to other trials besides the combination of abiotic cholic acid and bezafibrate. Are there other things that are in the pipeline that you're looking forward to? Oh, for sure. I mean, you know, I'm always looking forward to getting new drugs for my patients with PBC and PSC. You know, that I want the best for them. I want, I want to get rid of this inequity where it depends on where you live and who you see, which is why I want the most potent, most safe, most effective drug on label because then I know that everyone gets access to it and they don't all have to. Troop to see me in Toronto. So I'm particularly interested in the IBAT inhibitors. I think that's a really interesting approach to treating porietis. I've seen the excitement for my pediatric colleagues who now have access to licensed inhibitors for allergies and for PFIC and report to me the impact on their patients. These are very rare diseases, but they're impactful and they're symptomatic. So I'm watching with real interest to see what their data will come from the phase three clinical trials of inhibition in in PBC. About inhibition in, in PSC where you target just hits, you don't worry about the biochemistry. You say quality of life is what I'm interested in. You know, you may or may not have an elevator that fast, but does IBAT inhibition, does putting all those biases into your colon and removing them from your circulation lead to improvements in EDGE? And we want to see whether we see the same data as we see in Pediatrics and certainly what we've seen presenting at conferences and in papers if we sort of look at the class of effects. Of ideas and some of the, the, the data that's been repressed releases and conferences is that IBAT inhibition should be a good opportunity for our patients to target itching in particular in cholestatic liver disease. So without doubt very exciting and it's so much fun to have a toolbox beyond one class of drugs. I'll turn to you anything else besides I bet inhibitors that you're you're interest is peaked in. Yes. So I mean I base inhibitors have very much you know. Got a lot of attention for the main symptom that causes patients, you know, trouble in Paris. But now we are entering into an era of clinical trials where we're targeting other very difficult symptoms to manage like fatigue, cognitive impairment. And you know, for, you know, for example, you know, kind of going the locks alone, which can never pronounce properly is one of the first drugs that we are trialing for cognitive impairment, brain fog and fatigue. And historically, even 5-10 years ago, we would never have. Fault that there'd be a neurosteroid sort of, you know, targeted approach to the fatigue and cognitive impairment that's associated with chronic Cholestasis. And whether the trial would work, whether it has efficacy or not, we can only wait for the results. But the fact that the space is thinking about it and designing trials, you know, that are very complex, very challenging and sort of and very sort of detailed in their assessment of cognitive function in a chronic liver disease that's rare like BBC, you know, sort of is a huge step. Change forward for the field. And I'm very proud that PBC's really leading the way in this particular domain as a rare liver disease where we don't even have these sorts of trials in, in many other common conditions beyond perhaps encephalopathy. But you know, it's, it's, it's a very exciting time to be a researcher and a clinician who treats people with PBC in this era. Thank you both. Now I do understand that there are three of us are a little bit cholestatic nerdy, but hopefully this discussion is also excited. Those that do not want to be cholestatic experts to relook at their PVC patients understand that their toolbox is rapidly filling so that they can achieve, you know, remarkable results from their patients, which is not just, you know, slowing down the progression to transplant and death and cirrhosis, but actually, you know, you know, putting a stop sign. That progression for their disease and affecting quality of life and some of the symptoms that we used to, you know, minimize because we just didn't have a great approach like fatigue and peritus in this patient population. Are there any other thoughts that the two of you want to add before we conclude this program? Well, I just add, I'm proud you'd called me nerdy there. But it's not just about positions. It's about nurse practitioners, advanced advanced providers, physician assistants who are looking after these patients, particularly so in North America and the US. And it's about them believing that they can make a difference in, in the outcomes for patients. And you know, I, I, I, I know Nancy, you're on a world class transplant hepatologist, but the best thing a hepatologist can do is prevent transplantations. OK. And the best way to prevent transplantation is by making prompt diagnosis and by using your toolbox of therapies to really control the disease and the symptoms. And so when I see this data and the new labeled indications for, for different drugs in PBC and I look, as I said, I look at the different labels and I look at. The different trial date I can say to myself and I can say to the people they educate, the physicians, the nurse practitioners, physician assistants and the patient partners, OK, you can make a real impact by targeting which drugs are going to get you to the best normalization, which drugs are going to get you to the best peritus effect and the different patterns of patients, as we, as palate said, in fact, patients are not just, there's not just one type of PBC. So we're looking at the ALT response and things like that. So it's good to be a nerd because. Actually, the it's the nerds in the room who will prevent the transplants. And actually, that's really what patients want. Yes, I want you both to put me out of business. Absolutely. That's the best thing for our patients. Alright, that does conclude our discussion for today. I want to thank you both both for joining me and I really want to thank the audience for tuning in to this HCP Live special report. Thank you, thank you, Bye, bye. Thank you, Bye. Bye.To view or add a comment, sign in
Section Chief of Hepatology/Associate Director of Organ Transplantation at Rush University Medical Center
1dThank you Gideon and Palak for the great discussion. It's an exciting time for patients with cholestatic liver diseases