Obeticholic acid (Ocaliva) has been granted accelerated approval for use in combination with ursodeoxycholic acid (UDCA) for the treatment of primary biliary cholangitis in adults with an inadequate response to UDCA, and for use as a single therapy in adults unable to tolerate UDCA, the U.S. Food and Drug Administration announced.
Obeticholic acid should not be used in patients with complete biliary obstruction.
Given orally, obeticholic acid binds to the farnesoid X receptor (FXR), a receptor found in cells of the liver and intestine. FXR is a key regulator of bile acid metabolic pathways. Obeticholic acid increases bile flow from the liver and suppresses bile acid production in the liver, thus reducing exposure to toxic levels of bile acids.
Obeticholic acid was shown to reduce levels of alkaline phosphatase, which was used as a surrogate endpoint to predict clinical benefit, including an improvement in transplant-free survival. The FDA’s accelerated approval program allows approval based on a surrogate endpoint that is reasonably likely to predict clinical benefit. The manufacturer will conduct confirmatory clinical trials to examine any improvements in survival, progression to cirrhosis, or other disease-related symptoms.
After 12 months, in a controlled clinical trial with 216 participants, the proportion of participants achieving reductions in levels of alkaline phosphatase was higher among treated participants than in participants given placebo. Pruritus, fatigue, abdominal pain and discomfort, arthralgia, oropharyngeal pain, dizziness, and constipation were the drug’s most common side effects in the study.
Obeticholic acid is manufactured by Intercept Pharmaceuticals.