Which is better, obeticholic or deoxycholic acid?

Obeticholic acid(Obeticholic acid) and ursodeoxycholic acid (UDCA) are both bile acid drugs, but their mechanisms of action and clinical applications are significantly different. UDCA has been widely used in the management of primary biliary cholangitis (PBC) and other chronic cholestatic liver diseases since the 20th century and is the first-line standard treatment drug. UDCA relieves the disease by improving bile flow, reducing cholestasis, and reducing liver cell damage. Long-term use can delay disease progression and significantly improve biochemical indicators, especially alkaline phosphatase (ALP) and aminotransferase levels. It has a good safety profile and is highly tolerable, making it the drug of choice for long-term management of most PBC patients.

Obeeticholic acid is a selective FXR (farnesol FXR receptors play a key role in bile acid synthesis, transport, and regulation of liver fibrosis, so obeticholic acid can provide an additional treatment option for patients who have insufficient response to UDCA or are at higher risk of disease progression. Clinical studies have shown that OCA can improve the biochemical indicators of UDCA-insensitive patients and slow down the disease process. Especially when used in combination with UDCA, it can achieve a more significant decrease in ALP.

In terms of side effects,OCA may cause itching, increased blood lipids, or mild liver function abnormalities, while the side effects of UDCA are usually mild and rare. In clinical practice, doctors will consider the patient's condition, liver function status, and tolerance to decide on a single drug or combination drug regimen. Overall, UDCA is still the drug of choice, while obeticholic acid is mainly used as second-line or combination therapy, especially for patients with poor response to UDCA or rapid disease progression. The efficacy of the two is complementary, and the choice should be individualized.

Reference materials:https://en.wikipedia.org/wiki/Obeticholic_acid