Primary biliary cholangitis (PBC) is a progressive autoimmune liver disease, and patients with inadequate response to ursodeoxycholic acid (UDCA) treatment show reduced long-term survival. Recent studies have shown that fenofibrate is an effective off-label therapy for PBC. However, prospective studies on biochemical response including timing of fenofibrate administration are lacking. This study is aimed to evaluate the efficacy and safety of fenofibrate in UDCA treatment- naïve patients with PBC. A total of 117 treatment-naïve patients with PBC were recruited from the Xijing Hospital for a 12-month randomized, parallel and open-label clinical trial. Study participants were assigned to receive either UDCA standard dose (UDCA-only group) or fenofibrate at a daily dose of 200 mg in addition to UDCA (UDCA-Fenofibrate group). Primary outcome was biochemical response percentage in patients according to the Barcelona criterion at 12 month. In the UDCA-Fenofibrate group, 81.4% [69.9-92.9%] of the patients achieved the primary outcome and 64.3% [51.9-76.8%] in the UDCA-only group achieved (p = 0.048). There was no difference between two groups in noninvasive measures of liver fibrosis and biochemical markers other than alkaline phosphatase at 12 months. Creatinine and transaminases levels in the UDCA-Fenofibrate group increased within the first month, then returned to normal, and remained stable thereafter until the end of the study, even in patients with cirrhosis. In this randomized clinical trial in treatment-naïve patients with PBC, the combination of fenofibrate and UDCA resulted in a significantly higher biochemical response rate. Fenofibrate seemed to be well-tolerated in patients.