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EASL 2025 Retrospective: PBC
Primary Biliary Cholangitis in the Spotlight: A Retrospective on EASL 2025

Released: July 24, 2025

Palak J. Trivedi
Palak J. Trivedi, BSc, MBBS, PhD, MRCP, ESEGH
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Key Takeaways
  • A major highlight of EASL 2025 was the advancement of symptom-directed therapies for primary biliary cholangitis (PBC), including PPAR agonists and IBAT inhibitors.
  • This conference demonstrated a clear shift in ideology, towards thinking of PBC and other liver-related conditions as coexisting with each other, rather than in isolation.

The Spotlight on PBC
I found the 2025 EASL International Liver Congress particularly significant for several reasons. First of all, it was headlined by all the advances occurring in the cholestatic liver disease field, which is a big feat. Historically, conferences like this were dominated by research on fatty liver disease, now called metabolic dysfunction–associated steatotic liver disease (MASLD), and viral hepatitis. Now, it's the cholestasis field’s time to shine.

The Advent of Symptom-Directed Therapies for PBC
It follows, then, that the second significant theme that emerged at this year’s EASL Congress was achievement of profound developments in symptom‑directed therapies for primary biliary cholangitis (PBC), alongside validation of existing agents that are currently approved for the treatment of PBC.

If we look at how far we've come over the last 10 to 15 years in the cholestatic disease sphere, the growing emphasis on symptom‑specific therapy is truly striking. Slowing disease progression remains a key goal of PBC treatment, but we’ve come to recognize that addressing the extrahepatic symptoms of PBC are equally important, particularly in terms of relief from pruritus and fatigue.

More and more, investigators are presenting data that are more meaningful and impactful for patients in terms of quality of life. In particular, the post hoc analyses of elafibranor, a peroxisome proliferator-activated receptor (PPAR) agonist, compared to placebo for improvement of fatigue in patients with PBC showed that elafibranor was associated with clinically meaningful reductions in fatigue.

In terms of itch, I thought the data on the ileal bile acid transporter (IBAT) inhibitors were among the most impactful. Interim analyses from the VANTAGE study showed a significant difference in improvement of pruritus severity with volixibat compared to placebo. Furthermore, the landmark phase III GLISTEN study, which looked at the antipruritic therapy effects of linerixibat over a long period of time, demonstrated meaningful improvement of itch in patients with PBC. Although the high placebo response rate of this study can’t be ignored, we can still very clearly see the effect of this IBAT inhibitor on itch during crossover phase of the study. These sorts of symptom-directed therapies are really a landmark era for all our patients.

It was also nice to see validation of the efficacy and effectiveness of the newly licensed treatment, seladelpar, in terms of biochemistry and long-term health-related quality of life. Investigators of the phase III RESPONSE and its open-label extension, ASSURE, reported that seladelpar was associated with lower GLOBE scores and better transplant-free survival compared to placebo. Furthermore, in terms of extrahepatic symptoms of PBC, analyses from the RESPONSE and ENHANCE studies demonstrated that seladelpar improved pruritus for up to 6 months among people who had moderate to severe pruritus at baseline. 

PBC: No Longer in Isolation
The final thing I wanted to highlight from this conference is how the spotlight on PBC demonstrates that we are now in an era where PBC is no longer studied in isolation. Current research examines how comorbidities and dual etiologies exist alongside PBC and may affect PBC treatment and outcomes—particularly MASLD, which is more and more commonplace in the ongoing obesity pandemic. For example, abstracts were presented at EASL 2025 regarding the impact of assessing controlled attenuation parameter scores on the severity of PBC-associated steatosis, concomitant steatohepatitis, and the effects of coprescribing statins with existing PBC therapy.

In all, the emphasis on PBC at EASL 2025 is even more striking when taking into context the treatment landscape just 1 decade ago. If we rewind back to 2015, we were over the moon about just getting 1 drug, the first new drug for PBC licensed in decades. So in that span of time, from 2015 to 2025, the advent of new disease-modifying therapies has advanced PBC management at an incredibly rapid pace. Ultimately, I’m hoping to see continuation of these themes in future international liver congresses as well as in other international meetings like the upcoming American Association for Study of Liver Diseases meeting.

Your Thoughts
What presentations or posters did you find most intriguing or impactful at EASL 2025? Let us know by leaving a comment below!

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