Navigating Primary Biliary Cholangitis in Singapore: Addressing the Diagnostic Gap and the Next-Generation Therapies

• 90% Female Prevalence: PBC is a critical women's health issue, yet symptoms like crushing fatigue and relentless itching are frequently misdiagnosed as menopause or stress.
• 30-Year Innovation Gap: This new class of therapy is the first major breakthrough in three decades for the 40% of patients who do not respond to traditional treatments.
• Beyond the Blood Test: While 80% of patients suffer from crushing fatigue, this new era of care prioritises a woman's quality of life over just stable lab results.

Medical Channel Asia's spotlight on Primary Biliary Cholangitis (PBC) exposes how crushing fatigue and relentless itching drive severe isolation and misdiagnosis in women, highlighting a 30-year innovation gap that finally sees hope with next-generation targeted therapies.

SINGAPORE, June 18, 2026 /PRNewswire/ -- Primary Biliary Cholangitis (PBC) remains a complex and widely misunderstood condition within Singapore's healthcare landscape. As a chronic autoimmune disease that causes the gradual destruction of the liver's bile ducts, it affects women in 90% of cases. However, because its early progression is often asymptomatic or characterised by routine symptoms, a significant gap remains between the onset of the disease and a definitive diagnosis.

As medical awareness grows, the outlook for Singaporean patients is entering a hopeful new chapter. The clinical community is preparing for the arrival of a new class of breakthrough targeted therapies, representing the first major therapeutic innovation for PBC in thirty years.

The Clinical Profile: Why PBC Evades Early Detection

In a healthy liver, bile ducts act as a plumbing system to drain toxins. In patients with PBC, the immune system mistakenly attacks these ducts, leading to a toxic buildup of bile acids that causes chronic inflammation. If left unmanaged, this slow progression can result in permanent liver scarring (cirrhosis) and eventual liver failure.

Catching the disease early is the primary challenge for clinicians. The most common early symptoms carry no visible physical markers and are frequently sidelined:

• Itching (Pruritus): An intense, internal sensation that cannot be scratched, often leading to severe sleep deprivation, affecting up to 75% of people living with PBC
• Fatigue: An all-encompassing exhaustion that makes standard daily tasks feel insurmountable, affects up to 80% of people living with PBC

A patient may present with stable liver enzyme levels yet remain unable to sleep, concentrate at work, or engage with her family. This creates a central disconnect in care: the long-standing assumption that satisfactory biochemistry equals a patient who is thriving.

"If a patient continues to suffer from life-altering symptoms like relentless itching or extreme fatigue, their treatment cannot be considered fully effective — regardless of what the biochemistry suggests." — Professor Gideon Hirschfield, University of Toronto

Elevating the Standard of Care: Screening and Advanced Therapies

For the past three decades, the standard treatment framework for PBC was limited, relying primarily on ursodeoxycholic acid (UDCA). While UDCA slows the disease down to the point of minimal progression for many, it leaves roughly 40% of patients with an incomplete response and at ongoing risk of advanced liver damage.

"Although there are some treatments for itch (in PBC patients), approximately 40 per cent of patients do not respond to treatment. Severe, intractable (hard-to-control) itch is an indication for liver transplantation," says Dr. Thinesh Lee Krishnamoorthy, Senior Consultant at the Department of Gastroenterology and Hepatology at Singapore General Hospital (SGH) in CNA.

A new generation of targeted therapies is now arriving in Singapore, designed specifically to address the biological pathways that traditional treatments miss. These innovations represent a paradigm shift:

• Prioritising Quality of Life: Unlike previous therapies focused solely on slowing liver scarring, these new treatments target the biological triggers of itching and fatigue.
• Precise Care: By focusing on the specific mechanisms of bile acid production, these therapies offer a customised lifeline for those who previously had no further medical options.

The next-generation targeted therapies arriving in Singapore—such as elafibranor, which was registered locally in September 2025, and seladelpar—offer a highly anticipated shift in care. These incoming treatments have shown response rates of about 50% to 60% in patients who did not adequately respond to traditional options.

Rather than simply managing secondary effects, these therapies are designed to regulate bile acid production at the cellular level. "Both drugs have also demonstrated improvements in itch symptom scores, which is a major step forward in treating the disease," notes Dr. Thinesh. This precise mechanism of action brings renewed hope to the patient community by simultaneously slowing physical liver damage while directly relieving the biological drivers of fatigue and itch.

A Forward-Looking Approach to Long-Term Care

Across the ASEAN region, approximately 9% of the population is estimated to be living with a rare condition, though awareness and regulatory infrastructure remain in early development in several countries. Singapore's leadership in this space is defined by its ability to provide visibility and clinical pathways for conditions that have historically been the hardest to diagnose.

Singapore's robust rare disease framework, supported by initiatives like the Rare Disease Fund (RDF) and its 3-to-1 government matching grant, ensures that the healthcare infrastructure is well-positioned to adopt new clinical pathways. By encouraging proactive screening for at-risk demographics and introducing advanced, targeted therapies, Singapore is leading the way toward a more hopeful, predictable future for those living with PBC.

About Primary Biliary Cholangitis (PBC)

PBC is a rare, autoimmune liver disease where the build-up of bile and toxins causes chronic inflammation. It primarily affects women and can worsen over time if inadequately treated, potentially leading to the need for a liver transplant.

About Medical Channel Asia

Medical Channel Asia was created to help consumers access medical information from trustworthy sources and healthcare professionals. Medical Channel Asia reaches over 65 million users across social media and digital platforms, establishing itself as the largest healthcare media platform in the region.

SOURCE Medical Channel Asia