3.2.3. PPAR Agonists

There is a rising number of studies on the efficacy of fibrates in PSC. However, the majority of available data comes from observational or retrospective analyses [3]. A recent retrospective French-Spanish study reported a 40% reduction in ALP levels, together with amelioration of pruritus, after fenofibrate 200 mg/day or bezafibrate 400 mg/day treatment (median duration of therapy of about 1.5 years) in 20 PSC patients [91]. Interestingly, the authors reported a rebound in ALP levels after discontinuation of the PPAR agonist based on occurrence of biliary stones, tolerability, or worsening of liver tests. It has to be mentioned, however, that the liver stiffness evaluated by transient elastography significantly increased during the study. A small prospective study evaluated the efficacy of bezafibrate (200 mg bid) in 11 PSC patients. After 12 weeks of treatment, ALP and ALT levels significantly improved in 7 out of 11 (64%) patients and subsequently increased after treatment discontinuation [79]. Further studies on fibrates for PSC are warranted.
