Based on our current knowledge about therapies in hepatobiliary diseases, farnesoid X receptor (FXR) agonists (i.e., Obethicolic acid- OCA), which act through an increase in the transcription of various genes, including intestinal FGF-19, have shown benefits in both PBC, modulating the production and secretion of bile acids, and NASH individuals, potentially mitigating lipid dysregulation, influencing extracellular matrix reorganization and suppressing hepatic stellate cell activation. This evidence concerns the gene NR1H4 and metabolic dysfunction-associated steatohepatitis.