The efficacy and safety of bile Acid binding agents, opioid antagonists, or rifampin in the treatment of cholestasis-associated pruritus.
OBJECTIVE
The objective of this review was to evaluate the efficacy and safety of rifampin, opioid antagonists, or bile acid binding agents in the treatment of cholestasis-related pruritus (CAP) from available randomized controlled trial evidence.


METHODS
In addition to a comprehensive gray literature search, the Cochrane Library, MEDLINE, EMBASE, PubMed, and Web of Science were searched. Only full-text RCTs in participants (>75% adult) with CAP on at least one of the three medications were included. The primary outcome was change in pruritus score, recorded as a continuous or dichotomous outcome. Two independent reviewers performed trial selection and quality assessment.


RESULTS
From 487 citations, 12 RCTs were included. Rifampin (standardized mean difference [SMD]-1.62, 95% CI -3.05 to -0.18) and opioid antagonists (SMD -0.68, 95% CI -1.19 to -0.17) significantly reduced CAP. The two cholestyramine studies were too heterogeneous to pool. Although cholestyramine (P= 0.35) and rifampin (P= 0.96) were not associated with greater side effects compared with placebo, opioid antagonists were (number needed to harm = 2.6, 95% CI 1.4-25).


CONCLUSIONS
The available RCTs are small, few in number, and use varying scales for measuring pruritus. Although both opioid antagonists and rifampin demonstrated a reduction in pruritus, there were insufficient data to judge the efficacy of cholestyramine. Opioid antagonists were associated with transient side effects in a significant proportion of patients. A longer well-designed randomized controlled trial is needed to confirm the efficacy of bile acid binding agents and accurately assess adverse events.
Tandon
Puneeta
P
Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.
Rowe
Brian H
BH
Vandermeer
Ben
B
Bain
Vincent G
VG
D000924:Anticholesteremic Agents / Q000627:therapeutic use; D002779:Cholestasis / Q000150:complications*; D002792:Cholestyramine Resin / Q000627:therapeutic use*; D006801:Humans; D007917:Leprostatic Agents / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D011537:Pruritus / Q000188:drug therapy* / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D012293:Rifampin / Q000627:therapeutic use*; D016896:Treatment Outcome
D000924:Anticholesteremic Agents; D007917:Leprostatic Agents; D009292:Narcotic Antagonists; D002792:Cholestyramine Resin; D012293:Rifampin