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Monday Poster Session

Category: Biliary/Pancreas

P2142 - Efficacy and Safety of Peroxisome Proliferator-Activated Receptor Agonists in Primary Biliary Cholangitis: Systematic Review and Meta-Analysis

Monday, October 27, 2025
10:30 AM - 4:00 PM MT
Location: Exhibit Hall
Hareesha Rishab Bharadwaj, 1, Karan J.. Yagnik, MD2, Hassam Ali, MD3, Saqr Alsakarneh, MD, MSc4, Omar Al Ta’ani, MD5, Fariha Hasan, MD6, Sneh Sonaiya, MD, MPH, MBA7, Priyal Dalal, MD8, Sheza Malik, MD9, Syed Hasham Ali, MD10, Muhammad YN. Chaudhary, MBChB11, Dhruv Gandhi, MD12, Dushyant S. Dahiya, MD13
1The University of Manchester, Manchester, England, United Kingdom; 2Monmouth Medical Center, Robert Wood Johnson Medical School of Rutgers University, Long Branch, NJ; 3East Carolina University/Brody School of Medicine, Greenville, NC; 4Mayo Clinic, Rochester, MN; 5Department of Internal Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA, Pittsburgh, PA; 6Cooper University Hospital, Camden, NJ; 7Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas, Las Vegas, NV; 8School of Medicine, University of Central Lancashire, Preston, UK,, Preston, England, United Kingdom; 9Emory University, Atlanta, GA; 10Dow University of Health Sciences, Karachi, Punjab, Pakistan; 11Indiana University Southwest Internal Medicine Residency Program, Evansville, IN; 12St Francis Medical Center, Monroe, LA, Mumbai, Maharashtra, India; 13University of Kansas School of Medicine, Kansas City, KS

Introduction: Primary biliary cholangitis (PBC), an autoimmune liver disease, has the potential to advance to liver cirrhosis and result in fatality. Ursodeoxycholic Acid (UDCA) is the first-line treatment, while Obeticholic Acid (OCA) serves as a second-line option due to moderate UDCA non-responsiveness and cirrhosis-related concerns. Additional therapies are necessary due to recent warnings regarding OCA usage in cirrhotic patients. This study aimed to evaluate the efficacy and safety of peroxisome proliferator-activated receptor (PPAR) agonists in PBC.

Methods: We searched PubMed, Google Scholar, and the Cochrane Library until July 28, 2023. We included all RCTs that studied the efficacy and safety of PPAR agonists in treating PBC. The Primary outcome of interest was Alkaline phosphatase (ALP). In contrast, the secondary outcomes were Gamma-Glutamyl Transferase (GGT), Alanine Transaminase (ALT), Aspartate Aminotransferase (AST), Total Bilirubin (Tbil), Triglyceride and pruritis. We used a random-effects model to calculate the Risk Ratio (RR) and Standardized Mean Difference (SMD) with 95% CI.

Results: A total of 8 RCTs (n=515) were eligible for the analysis. Pooled data showed beneficial effects of PPAR agonists compared to placebo for ALP (SMD=-2.81, 95% CI = -4.10 to -1.51; p < 0.0001, I2 = 96%), GGT (SMD=-1.29, 95% CI=-2.09 to -0.48; p=0.002, I2=92%), TBili (SMD= -0.77, 95% CI=-1.32 to -0.22; p= 0.006, I2=86%), and Tg (SMD=-0.99, 95% CI=-1.63 to -0.35; P= 0.003, I2= 83%). There was no significant difference between PPAR agonists and placebo for ALT (SMD=-0.93, 95% CI=-1.94 to 0.08; p=0.07, I2=95%), AST (SMD= -0.01, 95% CI=-0.67 to 0.66; p=0.99, I2=91%), and pruritus (RR= 0.77, 95% CI=0.29 to 2.06; p=0.60, I2=34%).

Discussion: Our study found a superior efficacy of PPAR agonists compared to placebo for ALP, GGT, Tbili, and Tg, highlighting the potentially beneficial effect of PPAR agonists on liver health.


Figure: Forest plot showing Efficacy and Safety of Peroxisome Proliferator Activated Receptor Agonists in Primary Biliary Cholangitis.

Disclosures:
Hareesha Rishab Bharadwaj indicated no relevant financial relationships.
Karan Yagnik indicated no relevant financial relationships.
Hassam Ali indicated no relevant financial relationships.
Saqr Alsakarneh indicated no relevant financial relationships.
Omar Al Ta’ani indicated no relevant financial relationships.
Fariha Hasan indicated no relevant financial relationships.
Sneh Sonaiya indicated no relevant financial relationships.
Priyal Dalal indicated no relevant financial relationships.
Sheza Malik indicated no relevant financial relationships.
Syed Hasham Ali indicated no relevant financial relationships.
Muhammad Chaudhary indicated no relevant financial relationships.
Dhruv Gandhi indicated no relevant financial relationships.
Dushyant Dahiya indicated no relevant financial relationships.

Hareesha Rishab Bharadwaj, 1, Karan J.. Yagnik, MD2, Hassam Ali, MD3, Saqr Alsakarneh, MD, MSc4, Omar Al Ta’ani, MD5, Fariha Hasan, MD6, Sneh Sonaiya, MD, MPH, MBA7, Priyal Dalal, MD8, Sheza Malik, MD9, Syed Hasham Ali, MD10, Muhammad YN. Chaudhary, MBChB11, Dhruv Gandhi, MD12, Dushyant S. Dahiya, MD13. P2142 - Efficacy and Safety of Peroxisome Proliferator-Activated Receptor Agonists in Primary Biliary Cholangitis: Systematic Review and Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.