# New Trials Validate Accelerated PBC Drug Approvals Elafibranor and seladelpar achieve high alkaline phosphatase normalization rates in phase III trials. - **Source:** [MedPage Today](https://www.medpagetoday.com) - **Published:** 2026-11-06 - **Topic:** [health](https://brifing.si/c/health) - **Original article:** - **On Brifing:** https://brifing.si/s/b1f6a41c-d826-4273-a663-53f762578b05 ## Clinical Trial Success Recent phase III trials, ELSPIRE and IDEAL, confirm that elafibranor and seladelpar effectively normalize alkaline phosphatase levels in patients with primary biliary cholangitis. These findings support earlier accelerated approvals for both drugs. Researchers presented these significant results at the American Association for the Study of Liver Diseases annual meeting held in Denver. ## Targeting Intermediate Risk The studies focused on patients who showed incomplete responses or intolerance to first-line ursodeoxycholic acid therapy. Specifically, researchers targeted individuals with alkaline phosphatase levels between 1.0 and 1.67 times the upper limit of normal. This intermediate group faces long-term risks of adverse liver outcomes, making early biochemical normalization a critical clinical goal. ## ELSPIRE Study Results In the ELSPIRE trial, 85.3% of patients treated with elafibranor achieved alkaline phosphatase normalization at week 52, compared to 23.3% in the placebo group. The study included 92 participants with a median age of 61. These results demonstrate that normalization is a feasible therapeutic target when intervention occurs earlier in the disease stage. ## IDEAL Trial Findings The IDEAL trial reported that 75.4% of patients receiving seladelpar achieved normalization, versus 16.1% for the placebo group. Notably, the therapeutic effect appeared as early as one month into treatment. Among the 96 randomized participants, serious adverse events were reported in only 3.1% of the seladelpar group, showing a favorable safety profile. ## Predictive Clinical Markers Alkaline phosphatase has long served as a key predictor for long-term outcomes in primary biliary cholangitis patients. Previous trials like POISE established the 1.67 times upper limit threshold for defining biochemical response. By pushing for full normalization, clinicians aim to mitigate the increased risk of liver-related complications in patients with elevated enzyme levels. ## Safety and Side Effects Treatment-emergent adverse events were observed in 79% of elafibranor patients compared to 70% in the placebo group. Increased weight was specifically noted in 22.6% of those receiving elafibranor, with five cases linked directly to the medication. Conversely, no serious adverse events in the seladelpar group were deemed related to the study drug. ## Study Methodology Details Both trials utilized a 2:1 randomization ratio for drug versus placebo administration. Participants in ELSPIRE had a mean baseline alkaline phosphatase level of approximately 150 U/L and had been on ursodeoxycholic acid for a median of five years. These rigorous protocols ensure that the observed normalization is directly attributable to the new therapies. ## Future Treatment Implications These data provide essential evidence for managing an understudied patient population. By demonstrating that biochemical normalization is achievable, these trials offer clinicians clearer guidance for treatment decisions. Moving forward, the focus remains on whether these biochemical improvements translate into long-term survival benefits and reduced need for liver transplants in affected patients. ## Sources covering this story - https://www.medpagetoday.com/meetingcoverage/aasld/123768 — --- _Summary written by Brifing from the original reporting. Copyright in the original article belongs to its publisher; read the full piece at the link above._