title: Plasma separation and anion adsorption transiently relieve intractable pruritus in primary biliary cirrhosis.
abstract: OBJECTIVE
  Pruritus can be a severely disabling symptom in patients with primary biliary cirrhosis who do not respond to treatment with ursodeoxycholic acid, anion exchangers, enzyme inducers, or opiate antagonists. The aim of this study was to assess the clinical efficacy of plasma separation and anion adsorption in the treatment of intractable pruritus of cholestasis.
  
  
  METHODS
  Three patients with primary biliary cirrhosis and intractable pruritus defined by severity of pruritus 7 on a rating scale between 0 (no pruritus) and 10 (maximal pruritus) on at least 4 of 7 days despite medical treatment were treated with plasma separation and anion adsorption on three consecutive days. Fatigue was assessed using the Fisk Fatigue Severity Score and quality of life was assessed by the PBC-40, a disease specific health related quality of life measure.
  
  
  RESULTS
  Improvement in pruritus, fatigue, and quality of life was transiently observed in all patients. Serum bile acid levels showed no association with intensity of pruritus, and the bile acid pattern was not altered. The treatment was well tolerated by all patients.
  
  
  CONCLUSIONS
  Plasma separation and anion adsorption seem to be a safe and effective therapeutic option for patients with primary biliary cirrhosis suffering from intractable pruritus.
authors.affiliation: Department of Medicine II, Klinikum Grosshadern, University of Munich, Munich, Germany. thomas.pusl@med.uni-muenchen.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Pusl
authors.forename: Gerald U
authors.initials: GU
authors.lastname: Denk
authors.forename: Klaus G
authors.initials: KG
authors.lastname: Parhofer
authors.forename: Ulrich
authors.initials: U
authors.lastname: Beuers
mesh_terms: D000327:Adsorption; D000328:Adult; D000838:Anions / Q000493:pharmacokinetics*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000150:complications* / Q000378:metabolism; D008875:Middle Aged; D010865:Pilot Projects; D010956:Plasmapheresis / Q000379:methods*; D011537:Pruritus / Q000209:etiology / Q000378:metabolism / Q000628:therapy*
chemical_list: D000838:Anions