Obeticholic acid is an analog of chenodeoxycholic acid, a bile acid, and additionally selectively activates the farnesoid X receptor (FXR).11 Farnesoid X receptor activation through OCA has been associated with lower rates of hepatic fibrosis and inflammation.11 It was first shown to offer a benefit to UDCA non-responders by Hirschfield et al11 in a phase 2 randomized control trial (RCT), showing significant reductions in alkaline phosphatase at 1 year. The gene discussed is NR1H4; the disease is Hepatic fibrosis.