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Obeticholic acid is an approved second\u2010line therapy for patients with PBC that are refractory to UDCA. Novel surrogate endpoints are required to identify individuals eligible for second\u2010line therapies. An inadequate biochemical response to UDCA is a useful predictor of poor outcomes in patients with PBC. In addition to UDCA effects on biochemical parameters, histological outcomes could be considered as candidate surrogate endpoints. Alterations in liver histology are used as surrogate endpoints in clinical studies. However, current staging systems are insufficient to determine PBC disease severity and progression because of the pathological heterogeneity of the disease. Histological features at baseline and biochemical response to UDCA treatment can affect the disease course of PBC. Therefore, novel surrogate endpoints must be represented by parameters characterized by histological outcomes and treatment responses in PBC. In this review, we discuss the existing histological parameters and newly created factors to identify patients with PBC who are at a high risk of developing end\u2010stage liver disease and, consequently, the potential need for additional treatments.<\/jats:p>","DOI":"10.1111\/hepr.13593","type":"journal-article","created":{"date-parts":[[2020,11,17]],"date-time":"2020-11-17T18:05:23Z","timestamp":1605636323000},"page":"31-38","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["The association of histological progression with biochemical response to ursodeoxycholic acid in primary biliary cholangitis"],"prefix":"10.1111","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3158-5318","authenticated-orcid":false,"given":"Tadashi","family":"Namisaki","sequence":"first","affiliation":[{"name":"Third Department of Internal Medicine Nara Medical University  Kashihara Nara 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