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Background Little was known about the disease burden and management of primary biliary cholangitis (PBC) in Hong Kong. Thus, we aimed to assess the disease burden and characteristics of PBC in our locality and identify predictors of treatment response.Methods This was a retrospective cohort study. 1,551 patients diagnosed with PBC between 2010 and 2023 in Hong Kong were identified from the Clinical Data Analysis and Reporting System and divided based on date of diagnosis (2010-2013/ 2014-2017/ 2018-2023). They were followed until death or 31 December 2024, whichever came earlier. Baseline demographics and disease characteristics were compared. Missing data were imputed by multiple imputation. Univariate and multivariable logistic regression models were employed to identify factors associated with treatment response, defined by Paris II criteria.Results Across the time periods, there was no significant change in baseline characteristics at diagnosis. However, there was a significant increase in initiation of UDCA within 6 months of diagnosis (p=0.001), and improvement in UDCA treatment response based on Paris I (p=0.003), Paris II (p=0.002) and GLOBE score (p=<0.001) ( IDDF2026-ABS-0398 Table 1). Based on Paris II criteria, the proportion of patients with UDCA treatment failure were 75.3% (2010-2013), 78.6% (2014-2017), 65.2% (2018-2023), respectively.At PBC diagnosis, factors including younger age (OR 0.972, 95% CI 0.957-0.988, p=0.001), lower platelet (OR 0.997, 95% CI 0.995-0.999, p=0.001), lower albumin (OR 0.939, 95% CI 0.905-0.975, p=0.001), higher alkaline phosphatase (OR 1.007, 95% CI 1.005-1.009, p=<0.001), negative antinuclear antibody (OR 0.655, 95% CI 0.454-0.945, p=0.024), were independently associated with UDCA treatment failure (IDDF2026-ABS-0398 Figure 1).Conclusions Earlier treatment initiation reflects better disease awareness and linkage of care. Despite improvement in UDCA treatment response across time periods, there was still a substantial proportion of patients with suboptimal biochemical response. Patients with high-risk features of treatment failure require closer monitoring for timely initiation of second-line treatment.Abstract IDDF2026-ABS-0398 Figure 1Abstract IDDF2026-ABS-0398 Table 1Temporal trend of PBC disease burden and characteristics in Hong Kong2010-20132014-20172018-2023P valueCharacteristics at Diagnosisn=482n=424n=645Mean Age (Years)65.4 (14.1)66.7 (14.2)66.5 (13.7)0.321Male (%)97 (20.1)79 (18.6)133 (20.6)0.722Cirrhosis (%)37 (7.7)33 (7.8)36 (5.6)0.256Liver Decompensation (%)16 (3.3)18 (4.2)21 (3.3)0.658AIH PBC Overlap (%)0 (0.0)3 (0.7)6 (0.9)0.116PBC Treatment and ResponseInitiation of UDCA Within 6 months of Diagnosis (%)376 (90.8)372 (96.1)584 (95.6)0.001Treatment duration of UDCA >=365 days (%)366 (88.4)340 (87.9)538 (88.1)0.970Use of Fenofibrate (%)48 (10.0)46 (10.8)88 (13.6)0.131Treatment Failure Defined by Paris I (%)137 (60.1)104 (58.8)116 (45.8)0.003Treatment Failure Defined by Paris II (%)198 (75.3)176 (78.6)187 (65.2)0.002Median GLOBE Score1.05 (0.04, 1.98)0.61 (-0.12, 1.53)0.39 (-0.27, 1.14)<0.001Note: Continuous variables were expressed as mean ± SD or median (interquartile range), while categorical variables were presented as n (%); AIH PBC Overlap, autoimmune hepatitis- primary biliary cholangitis overlap syndrome; UDCA, Ursodeoxycholic acidCalculation bases:UDCA initiation (within 6 months of diagnosis) and treatment duration (≥365 days): All patients diagnosed in the period who started UDCA.Treatment failure (Paris I/II criteria): Patients diagnosed in the period who started UDCA and had sufficient data to calculate the respective scores.