**4. Current Therapeutic Management with Patients Newly Diagnosed with PBC and PSC**

Overall, the current codified treatment for patients with PBC consists of UDCA, OCA, and bezafibrate. We provide a flowchart for the standard management of patients with a new diagnosis of PBC (Figure 1). Unfortunately, an analogue algorithm could not be performed for the management of PSC. As a matter of fact, as previously explained, there is not a codified treatment of PSC.

**Figure 1.** Current algorithm of the treatment in PBC.

#### **5. Conclusions**

In this review, we provided an update on the drugs in clinical use and an overview of the new molecules in evaluation for the treatment of PBC and PSC patients. Recently, a deeper understanding of the pathophysiology of these diseases unveiled new molecular targets and, consequently, offered new chances for treatment. Given the complex nature of PBC and PSC, it appears unlikely that a single drug will be able to address all patients for each disease correctly. Instead, the near future of the medical management of chronic cholestatic liver diseases will most probably rely on a combination of multiple drugs targeting different signaling pathways at different stages of the disease. It will be essential to design clinical trials to address these issues specifically and to guide clinical management. A better knowledge of the molecular basis of the diseases and a more detailed disease

stratification based on patient characteristics and disease behavior remain therefore the cornerstones to devise new effective treatments for PBC and PSC patients.

**Author Contributions:** M.M. (Marta Mazzetti) writing—original draft preparation, conceptualisation, methodology; G.M. data curation, writing—review and editing; M.M. (Martina Mancinelli) data curation, writing—review and editing; A.B. supervision, validation; M.M. (Marco Marzioni) supervision, validation; L.M. conceptualisation, validation, writing—review and editing. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Institutional Review Board Statement:** Not applicable.

**Informed Consent Statement:** Not applicable.

**Data Availability Statement:** No new data were created or analyzed in this study. Data sharing is not applicable to this article.

**Conflicts of Interest:** The authors declare no conflict of interest.

#### **References**

