Which is better, obeticholic acid or ursodeoxycholic acid?

Obeticholic acid and ursodeoxycholic acid (ursodeoxycholic acid) are both drugs used to treat primary biliary cirrhosis (PBC), but there are certain differences in their mechanisms, indications and efficacy.

Usodeoxycholic acid is a classic bile acid widely used in the treatment ofPBC. Its mechanism of action is mainly by improving the flow of bile and reducing cholestasis, thereby reducing liver damage and inflammation. Ursodeoxycholic acid can promote the excretion of bile salts and reduce the concentration of toxic bile salts in liver cells, thereby reducing liver cell damage and fibrosis. In addition, ursodeoxycholic acid also has immunomodulatory effects and can reduce local inflammatory reactions in the liver. This makes ursodeoxycholic acid the first-choice treatment for PBC, especially for patients with early or mild disease, as it can often effectively improve liver function and slow down the progression of the disease.

Obeeticholic acid is a new farnesoidX receptor (FXR) agonist, which not only improves bile flow, but also further reduces liver inflammation and fibrosis by inhibiting bile acid synthesis and reducing bile acid burden in hepatocytes. The use of obeticholic acid is suitable for patients who have a poor response to ursodeoxycholic acid or cannot tolerate UDCA, and studies have shown that it can provide better efficacy in some patients. In addition, obeticholic acid can improve liver bile flow while improving metabolic status, helping to reduce the risk of complications related to cholestasis.

In clinical practice, many doctors choose to use these two drugs together in order to obtain better therapeutic effects. Ursodeoxycholic acid can be used as a basic treatment, while obeticholic acid can be used as an auxiliary drug to enhance the therapeutic effect. For some severely ill patients, obeticholic acid alone has also shown certain efficacy.

Reference materials:https://pmc.ncbi.nlm.nih.gov/articles/PMC5723701/