Purpose of Review <p>This review aims to explore emerging therapies and evolving treatment goals in primary biliary cholangitis (PBC), providing an updated overview and focusing on strategies that would improve both clinical outcomes and symptom burden.</p> Recent Findings <p>Criteria for assessing UDCA response continue to evolve. While the concept of deep biochemical response has been proposed as a treatment target, further research is needed to implement this into routine clinical practice.</p> Summary <p>New agents such as obeticholic acid, seladelpar, and elafibranor have provided new treatment for patients who do not achieve an adequate response to UDCA. Each has a distinct pharmacologic profile that should be carefully considered when selecting second-line therapy. Overall, PBC management is shifting toward more individualized strategies based on both clinical risk and symptom burden. Advances in symptom-specific treatments for pruritus and fatigue also show promise for PBC patient care.</p>