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Review
A systematic approach to the management of cholestatic pruritus in primary biliary cirrhosis
  1. Vinod S Hegade1,
  2. Ruth Bolier2,
  3. Ronald PJ Oude Elferink2,
  4. Ulrich Beuers2,
  5. Stuart Kendrick3,
  6. David EJ Jones1
  1. 1Faculty of Medical Sciences, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
  2. 2Tytgat Institute for Liver and Intestinal Research, Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  3. 3GlaxoSmithKline Research and Development, Medicines Research Centre, Stevenage, Hertfordshire, UK
  1. Correspondence to Dr Vinod S Hegade, Clinical Research Fellow, NIHR Newcastle Biomedical Research Centre, Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK; Vinod.hegade{at}ncl.ac.uk

Abstract

Pruritus (itch) is an important symptom of primary biliary cirrhosis (PBC), an archetypal cholestatic liver disease. Cholestatic pruritus can be a debilitating symptom causing significant deterioration in patients’ quality of life. Effective management of pruritus in PBC involves awareness among clinicians to adequately assess its severity, and treatment with specific drug therapies in line with current practice guidelines. In PBC, antipruritic drugs are not universally effective and/or have significant side effects, and despite best efforts with various combinations of drugs, some patients remain significantly symptomatic, eventually opting for invasive or experimental treatments. Therefore, there is a clear unmet need for better alternative treatments for patients with refractory or intractable cholestatic pruritus. Recent advances in the understanding of pathogenesis of cholestatic pruritus and bile acid physiology have raised hopes for novel therapies, some of which are currently under trial. In this review, we aim to provide a practical guide to the management of this important and complex problem, discussing current knowledge and recent advances in the pathogenesis, summarise the evidence base for available therapeutic approaches and update potential novel future therapies for the management of pruritus in PBC.

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