What is the first-line treatment for primary biliary cholangitis?

• A. Antimitochondrial antibodies
• B. Prednisone
• C. Ursodeoxycholic acid
• D. Azathioprine

Answer: (C)

Ursodeoxycholic acid is the first-line treatment for primary biliary cholangitis because it helps improve bile flow and reduces the toxic effects of bile acids on the liver. It’s a hydrophilic bile acid that protects cholangiocytes, decreases cholestasis, and can slow disease progression, improving long-term outcomes. The typical dose is about 13–15 mg/kg per day, given in divided doses. Antimitochondrial antibodies are diagnostic, not therapeutic. Immunosuppressants like prednisone or azathioprine are not first-line therapies for this condition unless there’s an overlap with another autoimmune liver disease.