Management of Pruritus in Primary Biliary Cholangitis: A Narrative Review

Trivedi, Hirsh D.; Lizaola, Blanca; Tapper, Elliot B.; Bonder, Alan

doi:10.1016/j.amjmed.2017.01.037

Cited by 33 publications

(65 citation statements)

References 63 publications

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“…Rifampicin, an antibiotic which may act as a medicine against itching, may also be administered [28]. Opioid antagonists containing naloxone or naltrexone inhibit pruritus by their effects on the central nervous system [29].…”

Section: Treatment For Itchingmentioning

confidence: 99%

Introductory Chapter: Autoimmune Epithelitis - Discussion about Sjögren’s Syndrome and Primary Biliary Cholangitis

Maślińska¹

2019

Chronic Autoimmune Epithelitis - Sjogren's Syndrome and Other Autoimmune Diseases of the Exocrine Glands

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Section: Treatment For Itchingmentioning

confidence: 99%

Introductory Chapter: Autoimmune Epithelitis - Discussion about Sjögren’s Syndrome and Primary Biliary Cholangitis

Maślińska¹

2019

Chronic Autoimmune Epithelitis - Sjogren's Syndrome and Other Autoimmune Diseases of the Exocrine Glands

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“…Common symptoms that affect patients with PBC include but are not limited to fatigue, pruritus and bone disease. [2][3][4][5] Prevention and modulation of these symptoms remain the cornerstone of management in PBC.…”

Section: Introductionmentioning

confidence: 99%

<p>Osteoporosis in Primary Biliary Cholangitis: Prevalence, Impact and Management Challenges</p>

Trivedi¹,

Danford²,

Goyes³

et al. 2020

CEG

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Primary biliary cholangitis (PBC) is a chronic, cholestatic condition associated with symptoms that directly impact the quality of life in those afflicted with the disease. In addition to pruritus and fatigue, patients with PBC may develop metabolic bone disease from reduced bone density, such as osteopenia and osteoporosis. Osteoporosis increases the risk of fractures, as well as morbidity and mortality. The prevalence of osteoporosis in PBC is expected to increase in conjunction with the rising prevalence of PBC as a whole. Timely diagnosis, prevention and management of osteoporosis are crucial in order to optimize the quality of life. There is a paucity of data evaluating the management of osteoporosis in PBC. The optimal timing for diagnosis and monitoring is not yet established and is guided by expert opinion. National guidelines recommend screening for osteoporosis at the time of diagnosis of PBC. Monitoring strategies are based on results of initial screening and individual risk factors for bone disease. Identifying reduced bone density is imperative to institute timely preventive and treatment strategies. However, treatment remains challenging as efficacious therapies are currently lacking. The data on treatment of osteoporosis in PBC are mostly extrapolated from postmenopausal osteoporosis literature. However, this data has not directly translated to useful treatment strategies for PBC-related osteoporosis, partly because of the different pathophysiological mechanisms of the two diseases. The lack of useful preventive measures and efficacious treatment strategies remains the largest pitfall that challenges the management of patients with PBC. In this review, we comprehensively outline the epidemiology, clinical implications and challenges, as well as management strategies of PBC-related osteoporosis.

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“…It can range from mild to severe and can intensify in warmer temperatures 19. Of note, up to three-quarters of patients affected by PBC-related pruritus report this symptom prior to diagnosis 20 21. In some patients, OCA treatment is associated with increased pruritus, which may be managed with lifestyle changes and a variety of treatments 22.…”

Section: Introductionmentioning

confidence: 99%

Practical strategies for pruritus management in the obeticholic acid-treated patient with PBC: proceedings from the 2018 expert panel

Pate

Gutierrez²,

Frenette

et al. 2019

BMJ Open Gastroenterol

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Background and aimsThis article provides expert guidance on the management of pruritus symptoms in patients receiving obeticholic acid (OCA) as treatment for primary biliary cholangitis (PBC). PBC is a chronic, autoimmune cholestatic liver disease that affects intrahepatic bile ducts. If not adequately treated, PBC can lead to cholestasis and end-stage liver disease, which may require transplant. Timely treatment is therefore vital to patient health. Pruritus is a common symptom in patients with PBC. Additionally, the use of OCA to treat PBC can contribute to increased pruritus severity in some patients, adding to patient discomfort, decreasing patient quality of life (QoL), and potentially affecting patient adherence to OCA treatment.MethodsIn May 2018, a group of physician experts from the fields of gastroenterology, hepatology, and psychiatry met to discuss the management of pruritus in OCA-treated patients with PBC. Recognizing the importance of optimizing treatment for PBC, these experts developed recommendations for managing pruritus symptoms in the OCA-treated PBC patient based on their experience in clinical practice.ResultsThese recommendations include a comprehensive list of management strategies (including over-the-counter, prescription, and alternative therapies), guidance on titration of OCA to minimize pruritus severity, and an algorithm that outlines a practical approach to follow up with patients receiving OCA, to better assess and manage pruritus symptoms.ConclusionsPruritus associated with OCA therapy is dose dependent and often manageable, and with the proper education and tools, most pruritus cases can be effectively managed to minimize treatment discontinuation.

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Management of Pruritus in Primary Biliary Cholangitis: A Narrative Review

Cited by 33 publications

References 63 publications

Introductory Chapter: Autoimmune Epithelitis - Discussion about Sjögren’s Syndrome and Primary Biliary Cholangitis

Introductory Chapter: Autoimmune Epithelitis - Discussion about Sjögren’s Syndrome and Primary Biliary Cholangitis

<p>Osteoporosis in Primary Biliary Cholangitis: Prevalence, Impact and Management Challenges</p>

Practical strategies for pruritus management in the obeticholic acid-treated patient with PBC: proceedings from the 2018 expert panel

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