Additionally, the association between elevated pre-treatment ALT levels and UDCA treatment non-response is consistent with the literature.25 In a study evaluating UDCA treatment response in PBC patients with autoimmune hepatitis features, ALT levels were higher in the non-responsive group.26 In our study, PBC patients with elevated baseline ALT levels may represent PBC variants with autoimmune hepatitis features. This evidence concerns the gene GPT and primary biliary cholangitis.