Efficacy of Treatments for Cholestatic Pruritus: A Systemic Review and Meta-analysis

Abstract

Cholestatic itch is a disabling symptom that may be secondary to liver or biliary diseases. Management of cholestatic pruritus is complex. A systematic review and meta-analysis on the efficacy of treatments for cholestatic pruritus were performed. PubMed and Cochrane Library were searched using the algorithm “(hepatitis OR cholestatic OR liver) AND (pruritus OR itch) AND (management OR treatment OR treatments)” for 1975–2019. Of the 2,264 articles identified, 93 were included in a systematic review and 15 in a meta-analysis (studies evaluating pruritus with a visual analogue scale). Some treatments act by reducing levels of pruritogens in the enterohepatic cycle, others modify the metabolism or secretion of these pruritogens, or act on pruritus pathways. A further possible treatment is albumin dialysis. However, due to many heterogeneities in the reviewed studies it is difficult to identify and recommend an optimum treatment. Only 15 studies were included in the meta-analysis, due to the small number of randomized studies using a visual analogue scale.

Efficacy and safety of pharmacological interventions for pruritus in primary biliary cholangitis: A systematic review and meta-analysis

“…Unfortunately, due to lack of evidence-based evidence, the role of many drug interventions in the treatment of cholestatic pruritus, including PBC was uncertain. This result has also been confirmed in a recent related study ( Dervout et al, 2022 ).…”

Ditch the Itch: Propofol in the Management of Cholestatic Pruritus

“…8,13 There are conflicting studies regarding its efficacy in treating cholestatic pruritus. 7,9,14 Antihistamines lack true anti-pruritogenic effect though they help by providing sedation. 8 Propofol is an intravenous anesthetic agent that has been reported to be effective in the management of cholestatic pruritus.…”

“…8,13 There are conflicting studies regarding its efficacy in treating cholestatic pruritus. 7,9,14 Antihistamines lack true anti-pruritogenic effect though they help by providing sedation. 8…”

Managing pruritus in chronic liver disease: An in-depth narrative review

“…Fenofibrate can be considered an alternative, though its antipruritic efficacy is not as firmly established 7 . Clinical trials investigating the use of fenofibrate in cholestatic pruritus are currently unavailable 30,31 . However, a retrospective study by Lemoinne et al, 32 including 20 patients with primary sclerosing cholangitis who did not respond adequately to ursodeoxycholic acid (UDCA) monotherapy, was conducted to assess the impact of fibrates (fenofibrate micronized 200 mg/d or bezafibrate 400 mg/d) in combination with UDCA.…”

“…[7] Clinical trials investigating the use of fenofibrate in cholestatic pruritus are currently unavailable. [30,31] However, a retrospective study by Lemoinne et al, [32] including 20 patients with primary sclerosing cholangitis who did not respond adequately to ursodeoxycholic acid (UDCA) monotherapy, was conducted to assess the impact of fibrates (fenofibrate micronized 200 mg/d or bezafibrate 400 mg/d) in combination with UDCA. About 88% of the patients experienced significantly decreased pruritus intensity, including 3 who reported complete remission (p = 0.021).…”