The primary biliary cholangitis (PBC) therapeutic landscape is experiencing significant momentum with multiple regulatory milestones and an expanding pipeline of innovative treatments targeting this rare autoimmune liver disease.
Recent Regulatory Achievements
In June 2025, GSK announced that the US Food and Drug Administration has accepted for review the New Drug Application for linerixibat, an investigational targeted inhibitor of the ileal bile acid transporter (IBAT). The therapy is being evaluated for treating cholestatic pruritus in patients with PBC, with a Prescription Drug User Fee Act goal date set for March 24, 2026.
Earlier this year, Gilead Sciences achieved a major regulatory success when the European Commission granted conditional marketing authorization for seladelpar in February 2025. The orphan-designated product is approved for treating primary biliary cholangitis in combination with ursodeoxycholic acid (UDCA) in adults with inadequate response to UDCA alone, or as monotherapy for those unable to tolerate UDCA. This approval provides an important treatment option for people living with the rare liver disease across the European Economic Area.
Breakthrough Therapeutic Approaches
COUR Pharmaceuticals made significant progress in January 2025 when its CNP-104 received FDA Orphan Drug Designation. This treatment is positioned as potentially the first disease-modifying therapy for PBC by inducing tolerance to pathogenic activated PDC-E2 T-cells that drive bile duct inflammation, representing a novel mechanistic approach to treating the underlying disease process.
Active Clinical Development Programs
The PBC pipeline demonstrates robust activity with ongoing Phase III trials addressing both symptom management and disease modification. GlaxoSmithKline is conducting an open-label, non-comparator, global, multi-center, long-term safety study evaluating linerixibat in participants with cholestatic pruritus who participated in prior clinical trials.
Mirum Pharmaceuticals is advancing a randomized, double-blind, placebo-controlled study evaluating volixibat's efficacy and safety for treating cholestatic pruritus in PBC patients, while also assessing potential impacts on disease progression.
Intercept Pharmaceuticals is conducting a Phase 2 study evaluating obeticholic acid administered in combination with bezafibrate in subjects with primary biliary cholangitis who had inadequate response or were unable to tolerate ursodeoxycholic acid.
Promising Pipeline Candidates
Elafibranor (Genfit)
Elafibranor functions as a dual agonist of PPAR-α and PPAR-δ nuclear receptors, which play important roles in numerous processes involved in liver disease development. The drug candidate has demonstrated highly significant results in Phase 2 studies in PBC patients while maintaining a favorable tolerability profile. It has received both Breakthrough Therapy Designation and Orphan Drug Designation from the FDA for treating PBC in adults with inadequate response to UDCA.
In May 2025, Ipsen announced new data from two late-breaking presentations on IQIRVO (elafibranor) during the European Association for the Study of the Liver congress, highlighting the drug's impact on fatigue and providing mechanistic insights into anti-inflammatory and symptom-related effects.
ASC42 (Gannex Pharma)
ASC42 represents a novel non-steroidal, selective, potent FXR agonist currently in Phase II development. The compound showed positive results in Phase I studies with no pruritus observed and LDL-C levels remaining within normal range at the human therapeutic dose of 15 mg.
OP-724 (Ohara Pharmaceutical)
OP-724 is a synthetic small molecule inhibitor of cyclic AMP response element-binding protein (CREB)-binding protein (CBP)/β-catenin. Ohara Pharmaceutical obtained development rights from PRISM BioLab in 2018, and the drug is currently in Phase I clinical studies.
Market Landscape and Future Outlook
According to DelveInsight's analysis, the PBC pipeline includes 18+ active companies developing 20+ pipeline therapies. Leading companies in the space include Genfit, Zydus Discovery, Ohara Pharmaceutical, Chia Tai Tianqing Pharmaceutical Group, Novartis, and CymaBay Therapeutics.
The therapeutic candidates span various stages of development, from discovery through Phase III, with multiple routes of administration including oral, parenteral, intravenous, subcutaneous, and topical formulations. The pipeline encompasses diverse molecular approaches including monoclonal antibodies, peptides, polymers, small molecules, and gene therapy approaches.
The recent regulatory approvals and advancing clinical programs signal a transformative period for PBC treatment, offering hope for improved outcomes in this rare liver disease that affects bile ducts and can lead to progressive liver damage if left untreated.
