| E.1 Medical condition or disease under investigation | 
| E.1.1 | Medical condition(s) being investigated | 
| Primary Biliary Cholangitis and Moderate to Severe Hepatic Impairment |  | 
| E.1.1.1 | Medical condition in easily understood language | 
| Primary Biliary Cholangitis and Moderate to Severe Hepatic Impairment |  | 
| E.1.1.2 | Therapeutic area | Diseases [C] - Digestive System Diseases [C06] | 
| MedDRA Classification | 
| E.1.3 | Condition being studied is a rare disease | Yes | 
| E.2 Objective of the trial | 
| E.2.1 | Main objective of the trial | 
| To evaluate the PK of OCA and its conjugates, glyco-OCA and tauro-OCA, and OCA metabolite glucuronide compared with placebo. To evaluate the safety and tolerability of OCA treatment compared with placebo |  | 
| E.2.2 | Secondary objectives of the trial | 
| To evaluate the effect of OCA treatment compared to placebo on: − The MELD score and its components
 − CP score and its components
 − Liver biochemistry including total and direct bilirubin, alkaline phosphatase (ALP), and aminotransferases (alanine aminotransferase [ALT], aspartate aminotransferase [AST], and gamma glutamyl transaminase [GGT]), international normalized ratio (INR), creatinine, albumin, platelets
 − Biomarkers of bile acid synthesis and homeostasis including fibroblast growth factor 19 (FGF-19), 7α-hydroxy-4-cholesten-3-one (C4), and plasma bile acids
 |  | 
| E.2.3 | Trial contains a sub-study | No | 
| E.3 | Principal inclusion criteria | 
| 1. A definite or probable diagnosis of PBC (consistent with American Association for the Study of Liver Diseases [AASLD] and European Association for the Study of the Liver [EASL] Practice Guidelines, defined as having ≥2 of the following 3 diagnostic factors: • History of elevated ALP levels for at least 6 months
 • Positive antimitochondrial antibody (AMA) titer or if AMA negative or low titer (≤1:80), PBC specific antibodies (anti-GP210 and/or anti-SP100) and/or antibodies against the major M2 components (PDC E2, 2-oxo-glutaric acid dehydrogenase complex)
 • Liver biopsy consistent with PBC (collected at any time prior to Screening)
 2. Evidence of cirrhosis including at least one of the following:
 • Biopsy results consistent with PBC Stage 4
 • Liver stiffness as assessed by TE Value ≥16.9kPa
 • Clinical evidence in the absence of acute liver failure consistent with cirrhosis including: gastroesophageal varices, ascites, radiological evidence of cirrhosis (nodular liver or enlargement of portal vein and splenomegaly)
 • Combined low platelet count (<140 000/mm3) with
 - persistent decrease in serum albumin, or
 - elevation in prothrombin time/INR (not due to antithrombotic agent use), or
 -  elevated bilirubin (2× ULN)
 3. Satisfy the criteria of the modified CP classification for hepatic impairment during Screening:
 • Moderate:  CP-B (Scores 7 to 9) or
 • Severe:  CP-C (Scores 10 to12)
 4. MELD score of 6 to 24 at Screening
 5. Taking UDCA for at least 12 months (stable dose for ≥3 months) prior to Day 1, or unable to tolerate or unresponsive to UDCA (no UDCA for ≥3 months)
 
 |  | 
| E.4 | Principal exclusion criteria | 
| 1. Non-cirrhotic or cirrhotic CP-A (Mild; Score 5 to 6) 2. History of liver transplant or organ transplant
 3. History of alcohol or drug abuse within 12 months prior to Screening
 4. Current hepatic encephalopathy (as defined by a West Haven score of ≥2)
 5. History or presence of other concomitant liver diseases including:
 • Hepatitis C virus infection and RNA positive
 • Active hepatitis B infection; however, patients who have seroconverted (hepatitis B surface antigen and hepatitis B e antigen negative) may be included in this study after consultation with the Medical Monitor
 • Primary sclerosing cholangitis
 • Alcoholic liver disease
 • Definite autoimmune liver disease or overlap hepatitis
 • Gilbert’s Syndrome
 6. In the opinion of the Investigator, fluctuating or rapidly deteriorating hepatic function prior to randomization
 |  | 
| E.5 End points | 
| E.5.1 | Primary end point(s) | 
| Primary Objective: • To evaluate the pharmacokinetics (PK) of OCA and its conjugates, glyco-OCA and tauro-OCA, and metabolite OCA glucuronide compared with placebo
 • To evaluate the safety and tolerability of OCA treatment compared with placebo
 |  | 
| E.5.1.1 | Timepoint(s) of evaluation of this end point |  | 
| E.5.2 | Secondary end point(s) | 
| Secondary Objectives: • To evaluate the effect of OCA treatment compared to placebo on:
 − The model of end stage liver disease (MELD) score and its components
 − Child-Pugh (CP) score and its components
 − Liver biochemistry including total and direct bilirubin, alkaline phosphatase (ALP), and aminotransferases (alanine aminotransferase [ALT], aspartate aminotransferase [AST], and gamma glutamyl transaminase [GGT]), international normalized ratio (INR), creatinine, albumin, platelets
 − Biomarkers of bile acid synthesis and homeostasis including fibroblast growth factor 19 (FGF-19), 7α-hydroxy-4-cholesten-3-one (C4), and plasma bile acids
 |  | 
| E.5.2.1 | Timepoint(s) of evaluation of this end point |  | 
| E.6 and E.7 Scope of the trial | 
| E.6 | Scope of the trial | 
| E.6.1 | Diagnosis | No | 
| E.6.2 | Prophylaxis | No | 
| E.6.3 | Therapy | No | 
| E.6.4 | Safety | Yes | 
| E.6.5 | Efficacy | Yes | 
| E.6.6 | Pharmacokinetic | Yes | 
| E.6.7 | Pharmacodynamic | No | 
| E.6.8 | Bioequivalence | No | 
| E.6.9 | Dose response | No | 
| E.6.10 | Pharmacogenetic | No | 
| E.6.11 | Pharmacogenomic | No | 
| E.6.12 | Pharmacoeconomic | No | 
| E.6.13 | Others | No | 
| E.7 | Trial type and phase | 
| E.7.1 | Human pharmacology (Phase I) | No | 
| E.7.1.1 | First administration to humans | No | 
| E.7.1.2 | Bioequivalence study | No | 
| E.7.1.3 | Other | No | 
| E.7.1.3.1 | Other trial type description |  | 
| E.7.2 | Therapeutic exploratory (Phase II) | No | 
| E.7.3 | Therapeutic confirmatory (Phase III) | Yes | 
| E.7.4 | Therapeutic use (Phase IV) | Yes | 
| E.8 Design of the trial | 
| E.8.1 | Controlled | Yes | 
| E.8.1.1 | Randomised | Yes | 
| E.8.1.2 | Open | No | 
| E.8.1.3 | Single blind | No | 
| E.8.1.4 | Double blind | Yes | 
| E.8.1.5 | Parallel group | Yes | 
| E.8.1.6 | Cross over | No | 
| E.8.1.7 | Other | No | 
| E.8.2 | Comparator of controlled trial | 
| E.8.2.1 | Other medicinal product(s) | No | 
| E.8.2.2 | Placebo | Yes | 
| E.8.2.3 | Other | No | 
| E.8.2.4 | Number of treatment arms in the trial | 2 | 
| E.8.3 | The trial involves single site in the Member State concerned | No | 
| E.8.4 | The trial involves multiple sites in the Member State concerned | Yes | 
| E.8.4.1 | Number of sites anticipated in Member State concerned | 3 | 
| E.8.5 | The trial involves multiple Member States | Yes | 
| E.8.5.1 | Number of sites anticipated in the EEA | 26 | 
| E.8.6 Trial involving sites outside the EEA | 
| E.8.6.1 | Trial being conducted both within and outside the EEA | Yes | 
| E.8.6.2 | Trial being conducted completely outside of the EEA | No | 
| E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned | 
| Australia |  
| Brazil |  
| United States |  
| Belgium |  
| Estonia |  
| Germany |  
| Hungary |  
| Italy |  
| Lithuania |  
| Spain |  
| Switzerland |  
| United Kingdom |  
| Argentina |  | 
| E.8.7 | Trial has a data monitoring committee | Yes | 
| E.8.8 | Definition of the end of the trial and justification where it is not the last
                        visit of the last subject undergoing the trial | 
| Last Visit of Last Subject |  | 
| E.8.9 Initial estimate of the duration of the trial | 
| E.8.9.1 | In the Member State concerned years | 3 | 
| E.8.9.1 | In the Member State concerned months | 3 | 
| E.8.9.1 | In the Member State concerned days |  | 
| E.8.9.2 | In all countries concerned by the trial years | 4 | 
| E.8.9.2 | In all countries concerned by the trial months | 7 |