title: Management of Pruritus in Primary Biliary Cholangitis: A Narrative Review.
abstract: Primary biliary cholangitis is an autoimmune condition characterized by destruction of intrahepatic bile ducts. It causes debilitating symptoms that dramatically affect the patient's quality of life. Pruritus affects 60% to 70% of individuals with primary biliary cholangitis and leads to sleep disturbances, fatigue, depression, and suicidal ideation. A complete search was performed with studies from PubMed, EMBASE, Web of Science, Cochrane database, Countway Library, and CINAHL with specific search terms. This narrative review was prepared after a comprehensive literature review. Treating patients with cholestatic pruritus is challenging and may have a profound impact on quality of life. The standard of therapy for primary biliary cholangitis, ursodeoxycholic acid, does not have a beneficial effect in cholestatic pruritus. Patients often do not respond to conventional therapies such as cholestyramine, rifampicin, opioid antagonists, and sertraline. These therapies lack long-term efficacy and have side effects. Patients who have not responded to these initial treatments can be considered for experimental therapies or clinical trials. This review outlines the current and emerging treatment modalities for patients with primary biliary cholangitis who have pruritus.
authors.affiliation: Liver Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
authors.forename: Hirsh D
authors.initials: HD
authors.lastname: Trivedi
authors.affiliation: Department of Medicine, St Elizabeth's Medical Center, Brighton, Mass.
authors.forename: Blanca
authors.initials: B
authors.lastname: Lizaola
authors.affiliation: Department of Hepatology, University of Michigan, Ann Arbor.
authors.forename: Elliot B
authors.initials: EB
authors.lastname: Tapper
authors.affiliation: Liver Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass. Electronic address: abonder@bidmc.harvard.edu.
authors.forename: Alan
authors.initials: A
authors.lastname: Bonder
mesh_terms: D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D002761:Cholangitis / Q000150:complications* / Q000188:drug therapy; D003863:Depression / Q000209:etiology; D005221:Fatigue / Q000209:etiology; D006801:Humans; D011537:Pruritus / Q000150:complications / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D011788:Quality of Life; D012893:Sleep Wake Disorders / Q000209:etiology; D059020:Suicidal Ideation; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
chemical_list: D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid
keywords: Biliary injury; Cholestasis; Cholestatic pruritus; Primary biliary cholangitis; Pruritus