PBC 2nd line Rx pathway allowing use of Obeticholic Acid

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WPBC 2nd line Rx pathway_Oct 17

We can now prescribe Obeticholic acid (OCA) for patients who have failed to respond adequately to UDCA or are intolerant to UDCA. I believe all health boards have obtained/or are in the process of obtaining approval for OCA use. In Wales, we have set up a virtual panel and developed treatment pathway with the intention of having same Rx thresholds across Wales and avoid variations in practice. In addition, having an agreed national pathway will hopefully give confidence to each HB re: judicious use of OCA!


Attached is the guidance/referral form for using OCA in PBC for 2nd line therapy. The form should be:


  1. completed for any patient who is potentially suitable for Rx with OCA
  2. sent online to the virtual panel and outcome recorded (form sent back to referrer with outcome)
  3. Form should be updated with biochemical response after 6 and 12 months of OCA therapy
  4. Updated form should be e-mailed to the virtual panel after 12 months of therapy to agree long-term Rx plan


It is vital that all sections are completed to enable the virtual panel to decide on the outcome promptly. The form will be saved only for audit purposes and analysing response data. The treatment will be prescribed and monitored locally by each UHB (unlike England!)


Please contact if there are any queries – very happy to discuss anytime.


Best Wishes




Dr B Srivastava

Consultant Hepatologist

UHW, Cardiff

Ext – 47956