A 35-year-old man with ulcerative colitis presents with pruritus and elevated ALP. MRCP shows multifocal strictures and dilations of intrahepatic and extrahepatic bile ducts. He is diagnosed with primary sclerosing cholangitis. Despite 12 months of UDCA, his ALP remains elevated. Which statement about medical therapy in PSC is correct?

• A High-dose UDCA (28-30 mg/kg/day) has been shown to improve transplant-free survival
• B Obeticholic acid is FDA-approved for PSC with inadequate UDCA response
• C Oral vancomycin is first-line therapy for PSC
• D No medical therapy has been proven to improve transplant-free survival in PSC ✓

Explanation

Multiple trials have failed to demonstrate a survival benefit for any drug in PSC. High-dose UDCA did not improve outcomes and may be harmful. Obeticholic acid is not approved for PSC. Vancomycin has shown small uncontrolled benefits but is not established therapy. Endoscopic dilatation of dominant strictures and transplant remain the mainstays.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.