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Autoimmune biliary diseases is really a big bucket.
So when we think about that, it's primary biliary cholangitis, primary sclerosing cholangitis, and then a bucket of things that really don't fall into those categories, of which we sometimes call autoimmune cholangiopathy or AMA negative PBC. And I think that the first thing is understanding what you have up against you. So if we take PBC, 'cause none of these are particularly common, but if we take PBC, ursodeoxycholic acid is first-line therapy, very old drug, bile acid, and, you know, pretty well-tolerated, efficacious in about 60% of people who try it or take it. And when we talk about efficacy, it's generally biochemical remission, so improving the alkaline phosphatase, hoping to make sure that that bilirubin remains great.
Doesn't say anything about the treatment of the extrahepatic manifestation, so the other side to that is that there are symptoms that go along with PBC, many of which URSO may not improve.
And here, either from biochemical efficacy, so didn't get the place you wanted to from the labs, or from symptomatology, we have second-line therapies, two recently approved PPARs, drugs in development.
