{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T12:38:07Z","timestamp":1789562287788,"version":"build-2803163510"},"reference-count":23,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Nearly 40% of patients with primary biliary cholangitis (PBC) have an incomplete response to first\u2010line ursodeoxycholic acid (UDCA) therapy. Fenofibrate, a peroxisome proliferator\u2010activated receptor alpha (PPAR\u2010\u03b1) agonist, is an effective second\u2010line treatment for PBC. Compared to the recently FDA\u2010approved PPAR agonists, fenofibrate may provide a more cost\u2010effective and accessible alternative. However, longitudinal data on fenofibrate use in PBC are lacking. Here, we review our experience using fenofibrate in PBC and its long\u2010term effects on cholestatic biomarkers, prognostic scores, and fibrosis indices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Approach and Results<\/jats:title>\n                    <jats:p>This single\u2010centre retrospective cohort study examined PBC patients prescribed fenofibrate between 2012 and 2024 for persistent elevations in alkaline phosphatase (ALP) despite UDCA therapy. The study included 59 patients treated with fenofibrate for a mean duration of 44.8\u2009months. The overall median time to ALP normalisation was 9.5\u2009months. Of those who did not meet Paris II criteria prior to fenofibrate therapy, the median time to ALP normalisation was 11.2\u2009months. GLOBE prognostic scores significantly improved with fenofibrate therapy, while UK\u2010PBC scores and fibrosis index scores (FIB\u20104) remained stable. Fenofibrate was well\u2010tolerated by most patients, with only 5% of patients discontinuing therapy due to elevated liver enzymes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this long\u2010term cohort of PBC patients with insufficient response to UDCA, fenofibrate significantly improved cholestatic markers and prognostic scores over time. Given this, and its favourable safety profile, fenofibrate should be further considered as an accessible and affordable second\u2010line therapy in PBC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/apt.70574","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T09:58:51Z","timestamp":1771408731000},"page":"1410-1420","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Long\u2010Term Use of Fenofibrate as Second\u2010Line Therapy in Primary Biliary Cholangitis: A Retrospective Study"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-1218-9142","authenticated-orcid":false,"given":"Mariko","family":"Maxwell","sequence":"first","affiliation":[{"name":"Section of Digestive Diseases and Liver Center Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanhong","family":"Deng","sequence":"additional","affiliation":[{"name":"Yale School of Public Health  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bonnie","family":"Chen","sequence":"additional","affiliation":[{"name":"Section of Digestive Diseases and Liver Center Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina G.","family":"Silveira","sequence":"additional","affiliation":[{"name":"Section of Digestive Diseases and Liver Center Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8959-6036","authenticated-orcid":false,"given":"James L.","family":"Boyer","sequence":"additional","affiliation":[{"name":"Section of Digestive Diseases and Liver Center Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8941-6170","authenticated-orcid":false,"given":"David N.","family":"Assis","sequence":"additional","affiliation":[{"name":"Section of Digestive Diseases and Liver Center Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,18]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(20)31607\u2010X"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.14218\/JCTH.2019.00049"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2017.09.062"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.30145"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2009.01.003"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1509840"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.70378"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.27744"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1714519"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2312100"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2306185"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41575\u2010025\u201001135\u2010y"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinre.2015.02.011"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000001465"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2011.02.031"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28017"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2015.07.061"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000000557"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000001285"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpt.1930"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10753\u2010022\u201001713\u20101"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2022.06.017"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2020.10.001"}],"container-title":["Alimentary Pharmacology &amp; 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