Do PPAR agonists help reduce itching in primary biliary cholangitis?

Itching (pruritus) is a common and distressing symptom in primary biliary cholangitis (PBC), affecting about 1 in 3 patients ¹. Many people do not get adequate relief from standard treatments. PPAR agonists are a class of drugs that target specific receptors in the body. Research shows they can help reduce itching in PBC, particularly for those with moderate-to-severe symptoms ²⁶⁷.

What the research says

A 2025 meta-analysis of 5 randomized placebo-controlled trials involving 660 patients found that PPAR agonists (bezafibrate, elafibranor, and seladelpar) significantly reduced itch scores at 3, 6, and 12 months compared to placebo ². The reduction was most notable in patients who started with moderate-to-severe itching ².

In a phase 3 trial of seladelpar (a selective PPAR-delta agonist), patients with moderate-to-severe itching at baseline reported a meaningful decrease in itch scores by month 6 ⁸. Another study focusing on patients with compensated cirrhosis also showed seladelpar improved biochemical markers and was generally well-tolerated ⁵.

PPAR agonists are considered promising second-line therapies for PBC, especially for those who do not respond well to ursodeoxycholic acid (UDCA) ⁶⁷. Unlike obeticholic acid (another second-line drug), which can actually worsen itching, PPAR agonists tend to improve it ⁷.

What to ask your doctor

• Could a PPAR agonist like bezafibrate, elafibranor, or seladelpar be an option for my itching?
• What are the potential side effects of PPAR agonists, and how do they compare with other treatments?
• If I have moderate-to-severe itching, how much relief might I expect from a PPAR agonist?
• Are there any interactions between PPAR agonists and my current medications (including UDCA)?
• How long does it typically take to see improvement in itching after starting a PPAR agonist?