Sertraline as a first-line treatment for cholestatic pruritus.
Pruritus is frequently the most debilitating symptom of cholestatic liver diseases. Moreover, existing therapies are often ineffective. Recent small, retrospective case series reports suggest that serotonin reuptake inhibitors can improve pruritus. This study was undertaken to establish the dose of sertraline and to evaluate its efficacy for cholestatic pruritus. Twenty one subjects with chronic pruritus due to liver disease (including primary biliary cirrhosis, primary sclerosing cholangitis, chronic hepatitis C, and postnecrotic cirrhosis) initially underwent an open-label, dose escalation to determine the dose with optimal efficacy and tolerability. After a washout period, 12 of the subjects entered a randomized, double-blind, placebo-controlled trial. Participants quantified their pruritus using a 0-10 visual analog scale, and pruritus was assessed for distribution, timing, degree of disability, and physical evidence of scratching. The optimum sertraline dose (75-100 mg/day) was well tolerated. In the controlled portion of the study, itch scores improved in patients taking sertraline, but worsened in patients taking placebo (P=0.009). Changes in itch distribution, duration, direction, and physical evidence of scratching paralleled changes in the visual analog pruritus score.


CONCLUSIONS
Sertraline seems to be an effective, well-tolerated treatment for pruritus due to chronic liver disease. These results suggest that serotonergic pathways are important in the perception of itch.
Mayo
Marlyn J
MJ
Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390-9151, USA. marlyn.mayo@utsouthwestern.edu
Handem
Iorna
I
Saldana
Sandra
S
Jacobe
Heidi
H
Getachew
Yonas
Y
Rush
A John
AJ
D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002780:Cholestasis, Intrahepatic / Q000150:complications*; D002908:Chronic Disease; D018592:Cross-Over Studies; D003863:Depression / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement; D010865:Pilot Projects; D011446:Prospective Studies; D011537:Pruritus / Q000188:drug therapy* / Q000209:etiology* / Q000473:pathology; D020280:Sertraline / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D000928:Antidepressive Agents; D020280:Sertraline