*Review* **The Management of Cholestatic Liver Diseases: Current Therapies and Emerging New Possibilities**

**Marta Mazzetti 1,2,\*, Giulia Marconi 1, Martina Mancinelli 1, Antonio Benedetti 1, Marco Marzioni <sup>1</sup> and Luca Maroni <sup>1</sup>**


**Abstract:** Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are two chronic cholestatic liver diseases affecting bile ducts that may progress to biliary cirrhosis. In the past few years, the increasing knowledge in the pathogenesis of both diseases led to a growing number of clinical trials and possible new targets for therapy. In this review, we provide an update on the treatments in clinical use and summarize the new drugs in trials for PBC and PSC patients. Farnesoid X Receptor (FXR) agonists and Pan-Peroxisome Proliferator-Activated Receptor (PPAR) agonists are the most promising agents and have shown promising results in both PBC and PSC. Fibroblast Growth Factor 19 (FGF19) analogues also showed good results, especially in PBC, while, although PBC and PSC are autoimmune diseases, immunosuppressive drugs had disappointing effects. Since the gut microbiome could have a potential role in the pathogenesis of PSC, recent research focused on molecules that could change the microbiome, with good results. The near future of the medical management of these diseases may include new treatments or a combination of multiple drugs targeting different signaling pathways at different stages of the diseases.

**Keywords:** primary biliary cholangitis (PBC); primary sclerosing cholangitis (PSC); clinical trials; ursodeoxycholic acid (UDCA); Farnesoid X Receptor (FXR) agonist; Pan-Peroxisome Proliferator-Activated Receptor (PPAR) agonists
