Progressive familial intrahepatic cholestasis produces relentless itching from accumulated bile acids, and surgical biliary diversion was long one of the few options. Bylvay (odevixibat) provided a pharmacological alternative.
Odevixibat blocks bile acid reabsorption in the distal intestine, lowering the serum levels that drive severe itch. The once-daily capsule, with a pellet formulation for young children, is approved to treat pruritus in patients with progressive familial intrahepatic cholestasis.
Bylvay has since expanded into Alagille syndrome and holds orphan designation with no generic competition. It competes directly with maralixibat across overlapping cholestatic indications, making label breadth and pediatric formulation the decisive commercial factors.
