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This retrospective study characterizes the clinical, biochemical, and treatment patterns of 287 patients diagnosed with Primary Biliary Cholangitis (PBC) under the care of a large regional teaching hospital in South Yorkshire. Patient ages at diagnosis ranged from 22 to 87 years, with the majority (n = 95) diagnosed between 50 and 59 years, aligning with the typical demographic profile of PBC. Treatment patterns revealed that 87% of patients were receiving Ursodeoxycholic acid (UDCA), the first-line therapy, while 27% were prescribed second-line treatments, including Bezafibrate (31 patients), Obeticholic acid (20 patients), and Elafibranor (8 patients). Notably, 7% of patients were not on disease-modifying therapy, although 17 had documented clinical reasons for this, leaving only 4 without a clear justification.Despite treatment efforts, over 58% of patients had not achieved normalization of alkaline phosphatase (ALP), a key biochemical marker of disease activity. Furthermore, 24% had ALP levels exceeding 1.67 times the upper limit of normal (ULN), which is associated with a higher risk of disease progression. Among those with ALP >1.67 ULN, 18 patients had sub-therapeutic dosing of UDCA, accounting for 25% of this group, suggesting a significant gap in disease control.Risk stratification identified 51 patients (18%) at high risk of hepatic decompensation, underscoring the significant burden of advanced disease within the cohort. Additionally, in the most recent clinic review, 218 patients had their fatigue and pruritus assessed, with 93 patients reporting significant pruritus, reflecting the substantial symptom burden and impact on quality of life for many patients with PBC.Mortality analysis revealed that 47 of the 287 patients had died, with 10 deaths attributed to liver-related causes, highlighting the progressive nature of PBC in a subset of patients. These findings emphasize the need for early identification of high-risk individuals and prompt intervention to improve outcomes.This dataset provides valuable insights into real-world treatment patterns, disease control, and risk factors for PBC in a UK population. It highlights the ongoing challenges in achieving optimal biochemical control and the importance of personalized treatment strategies, including appropriate risk stratification and timely escalation of therapy. Furthermore, analysis of this data underscores how current practice is producing suboptimal results and paves the way for newer therapies, such as Elafibranor or Seladelpar, in the hope of achieving normalization of ALP and, ultimately, improving long-term quality of life (QOL) for patients. These findings offer a foundation for future research aimed at improving outcomes for patients with PBC.