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Physician Experience

KOL Interview

In this expert spotlight, Dr. Nancy Reau of RUSH University Medical Center addresses two of the most pressing challenges in the management of Primary Biliary Cholangitis (PBC): delayed diagnosis and delayed treatment escalation. Drawing from clinical insights and institutional data, Dr. Reau discusses how symptoms such as fatigue, pruritus, and elevated alkaline phosphatase often go unrecognized for years—resulting in delayed initiation of therapy. She highlights the importance of earlier testing with antimitochondrial and PBC-specific antinuclear antibodies to improve time to diagnosis. Dr. Reau also examines the hesitancy among clinicians to escalate therapy beyond ursodeoxycholic acid (UDCA), despite new FDA-approved second-line treatments such as obeticholic acid and PPAR agonists. With clear benchmarks like alkaline phosphatase normalization and bilirubin control now guiding treatment response, she calls for timely intervention to improve prognosis, transplant-free survival, and quality of life in patients with PBC.