Mode
Text Size
Log in / Sign up

FDA approved Cholbam (cholic acid) for Bile Acid Synthesis Disorders and Peroxisomal DisordersFDA approved first treatment for rare bile acid disorders.

AI-generated summary of the cited source, checked by automated accuracy review. How we work

Key Takeaway
Consider Cholbam for bile acid synthesis disorders and peroxisomal disorders with liver involvement; monitor liver function closely and discontinue if no improvement in 3 months.

The FDA has approved Cholbam (cholic acid) for the treatment of bile acid synthesis disorders due to single enzyme defects (SEDs) and as adjunctive treatment for peroxisomal disorders (PDs) including Zellweger spectrum disorders in patients with liver disease, steatorrhea, or complications from decreased fat-soluble vitamin absorption. This is the first FDA-approved treatment for these rare, often fatal conditions. Cholbam is a bile acid that replaces deficient bile acids, improving liver function and fat absorption. The approval provides a targeted therapy for patients with these inherited metabolic disorders, though the label notes that safety and effectiveness on extrahepatic manifestations have not been established. Clinicians should monitor liver function closely and discontinue if no improvement within 3 months.

Clinical Details (Mechanism · Dosing · Trial Data · Warnings)
Mechanism of Action

Cholbam (cholic acid) is a bile acid that replaces deficient bile acids in patients with bile acid synthesis disorders due to single enzyme defects and peroxisomal disorders. It promotes bile flow and absorption of fat-soluble vitamins.

Indication & Patient Population

Cholbam is indicated for treatment of bile acid synthesis disorders due to single enzyme defects (SEDs) and as adjunctive treatment of peroxisomal disorders (PDs) including Zellweger spectrum disorders in patients who exhibit manifestations of liver disease, steatorrhea, or complications from decreased fat-soluble vitamin absorption. Limitations: Safety and effectiveness on extrahepatic manifestations have not been established.

Dosing & Administration

Recommended dosage: 10 to 15 mg/kg once daily or in two divided doses, in pediatric patients and adults. For patients with concomitant familial hypertriglyceridemia: 11 to 17 mg/kg once daily or in two divided doses, adjusted based on clinical response. Administer with food. Capsules can be opened and mixed with drink/food for patients unable to swallow. Monitor AST, ALT, GGT, alkaline phosphatase, bilirubin, and INR monthly for first 3 months, every 3 months for next 9 months, every 6 months for next 3 years, then annually. Discontinue if liver function does not improve within 3 months, if complete biliary obstruction develops, or if persistent worsening of liver function or cholestasis occurs.

Key Clinical Trial Data

Trial data not available in label.

Warnings & Contraindications

Discontinue if liver function does not improve within 3 months, if complete biliary obstruction develops, or if persistent clinical or laboratory indicators of worsening liver function or cholestasis occur. Concurrent elevations of serum GGT and serum ALT may indicate overdose. Monitor liver function and consider restarting at a lower dose when parameters return to baseline.

Place in Therapy

Cholbam is a first-line replacement therapy for bile acid synthesis disorders due to SEDs and adjunctive treatment for peroxisomal disorders. It should be initiated and monitored by an experienced hepatologist or pediatric gastroenterologist. It addresses liver disease and fat malabsorption but has not been shown to affect extrahepatic manifestations.

The FDA has approved a new drug called Cholbam (cholic acid) for two rare genetic conditions: bile acid synthesis disorders and certain peroxisomal disorders like Zellweger spectrum disorders. These conditions can cause serious liver problems and trouble absorbing fat and vitamins. Cholbam is a bile acid that replaces the ones the body cannot make, helping the liver work better and improving fat absorption. This is the first FDA approved treatment for these often fatal diseases.

Cholbam is for patients who have liver disease, fatty stools, or problems from not absorbing fat soluble vitamins. It is taken by mouth and must be used under a doctor's care. Doctors will check liver function regularly and stop the drug if there is no improvement after three months.

The approval gives patients a targeted therapy for a previously untreatable condition. However, the drug has not been shown to help with symptoms outside the liver. Patients should talk to their doctor about whether Cholbam is right for them and what to expect from treatment.

What this means for you:
Cholbam is a new bile acid replacement for rare liver disorders, but it does not treat all symptoms.

Study Details

Study typeFda approval
PublishedMar 2015
View Original Abstract ↓
1 INDICATIONS AND USAGE CHOLBAM is a bile acid indicated for: • Treatment of bile acid synthesis disorders due to single enzyme defects (SEDs). ( 1.1 ) • Adjunctive treatment of peroxisomal disorders (PDs) including Zellweger spectrum disorders in patients who exhibit manifestations of liver disease, steatorrhea or complications from decreased fat-soluble vitamin absorption. ( 1.2 ) Limitations of use: The safety and effectiveness of CHOLBAM on extrahepatic manifestations of bile acid synthesis disorders due to SEDs or PDs including Zellweger spectrum disorders have not been established. ( 1.3 ). 1.1 Bile Acid Synthesis Disorders Due to Single Enzyme Defects CHOLBAM is indicated for the treatment of bile acid synthesis disorders due to single enzyme defects (SEDs). 1.2. Peroxisomal Disorders Including Zellweger Spectrum Disorders CHOLBAM is indicated for adjunctive treatment of peroxisomal disorders (PDs) including Zellweger spectrum disorders in patients who exhibit manifestations of liver disease, steatorrhea or complications from decreased fat-soluble vitamin absorption. 1.3. Limitations of Use The safety and effectiveness of CHOLBAM on extrahepatic manifestations of bile acid synthesis disorders due to SEDs or PDs including Zellweger spectrum disorders have not been established.
Free Newsletter

Clinical research that matters. Delivered to your inbox.

Join thousands of clinicians and researchers. No spam, unsubscribe anytime.