How do you manage liver enzyme elevations in patients with PBC after starting elanifibranor?

It depends on what is elevated. If the ALP is increasing (or stable), did the patient stop UDCA or obetacholic acid when starting elafibranor? Is adherence to elafibranor an issue?

Is the patient also on concomitant medications that have drug interactions? Statins can have DDI with PPARs.

I would also check the patients isn't on supplements that can lead to liver injury.

I am not aware of convincing evidence that elafibranor leads to serious DILI, but it has rarely been linked to elevating LTs. If none of the above fit, then perhaps, stopping the elefibranor and see what happens to the LTs. I would probably recheck the LTs and ask the above questions before stopping the elafibranor.