A 58-year-old woman with a history of PBC presents to your clinic for follow-up. She

A 58-year-old woman with a history of PBC presents to your clinic for follow-up. She has been on ursodeoxycholic acid (UDCA) at a dose of 13 mg/kg/day for the past year. Her recent laboratory results show an alkaline phosphatase (ALP) level of 200 U/L (normal range: 30-120 U/L) and a total bilirubin level of 1.2 mg/dL (normal range: 0.1-1.0 mg/dL). She reports persistent fatigue and moderate pruritus, despite treatment with cholestyramine. What is the most appropriate next step in managing this patient? a. Continue UDCA monotherapy and re-evaluate in 6 months b. Increase the dose of UDCA to 15 mg/kg/day c. Initiate treatment with elafibranor 80 mg daily d. Initiate treatment with obeticholic acid 5 mg daily

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