Mindfulness - Based Intervention in the Treatment of Fatigue in Patients With Primary Biliary Cholangitis

Aim 1: To assess the efficacy of mindfulness-based intervention (MBI) in the treatment of
moderate or severe fatigue in patients with primary biliary cholangitis (PBC).

Hypothesis: MBI is feasible in PBC patients with fatigue and will result in improvement in
symptoms of fatigue.

Aim 2: To assess the impact of MBI in physical activity levels, daytime somnolence, autonomic
symptoms, functional status, cognitive dysfunction and anxiety and depressive symptoms of
patients with PBC with moderate or severe fatigue.

Hypothesis: MBI will result in an improvement in physical activity levels, daytime
somnolence, autonomic symptoms, functional status, cognitive dysfunction and anxiety and
depressive symptoms in patients with PBC who have moderate or severe fatigue.

Aim 3: To evaluate the effects of MBI on candidate markers and/or cytokines of fatigue and
physiological stress, including hepatic panel, antimitochondrial (AMA) titers, IL-1β, IL-6,
TNFα, cortisol, leptin, CRP, BDNF, MIF, and CD74 levels and other relevant markers.

Hypothesis: MBI will result in a decrease of levels of above mentioned markers of fatigue and
physiological stress in patients with PBC who have moderate or severe fatigue.

Inclusion Criteria:

- Primary Biliary Cholangitis as defined by previously published criteria

- On stable therapy with UDCA for at least 6 months before enrollment

- Primary Biliary Cholangitis-40 fatigue domain score > 33

- The ability to provide written consent

Exclusion Criteria:

- A known medical condition or metabolic disorder sufficient to explain fatigue such as
anemia, thyroid disease, renal failure, use of beta-blockers and untreated depression

- Active drug or alcohol use or history of drug and/or stimulant abuse

- History of psychosis

- Modification of treatment for underlying PBC in the preceding six months

- Other serious coexistent conditions such as pre-existing advanced malignancy or severe
cardiopulmonary disease which would be expected to limit their life expectancy

- Anticipated need for transplantation in one year (Mayo survival model <80% one-year
survival without transplant) or MELD above 15

- Recurrent variceal bleeding, presence of diuretic-resistant ascites, or spontaneous
encephalopathy

- Non-proficiency in English