In a double-blind, randomized, placebo-controlled study including 217 patients 
with primary biliary cholangitis, the authors show that obeticholic acid (a 
potent farnesoid X agonist) administered with ursodeoxycholic acid or as 
monotherapy significantly decreases serum alkaline phosphatase and bilirubin 
when compared to placebo. Pruritus (and serious adverse effects) was observed 
more frequently in obeticholic acid-treated patients than in controls, in spite 
of a decrease in serum bile acid concentration. These results are encouraging, 
but more studies are needed on clinical efficacy and safety before obeticholic 
acid can be widely recommended.