Ursodeoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy: a randomized controlled trial

Joutsiniemi, Titta; Timonen, Susanna; Leino, Riitta; Palo, Pertti; Ekblad, Ulla

doi:10.1007/s00404-013-2995-5

Cited by 37 publications

(25 citation statements)

References 22 publications

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“…Opioids, serotonin, and female sex hormones have all been implicated in the etiology of pruritus. Increased levels of endogenous opioids are reported in chronic liver disease [ 18 , 19 ] and treatment with an opioid antagonist is shown to reduce pruritus [ 20 – 22 ]. Serotonin is believed to induce pruritus by altering itch perception [ 17 ] and so serotonin reuptake inhibitors such as sertraline have reported to be effective in managing pruritus [ 23 ].…”

Section: Resultsmentioning

confidence: 99%

Management of Pruritus in Chronic Liver Disease

Bhalerao

Mannu

2015

Dermatology Research and Practice

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Background. There continues to be uncertainty on the ideal treatment of pruritus in chronic liver disease. The aim of this study was to gather the latest information on the evidence-based management of pruritus in chronic liver disease. Methodology. A literature search for pruritus in chronic liver disease was conducted using Pubmed and Embase database systems using the MeSH terms “pruritus,” “chronic liver disease,” “cholestatic liver disease,” and “treatment.” Results. The current understanding of the pathophysiology of pruritus is described in addition to detailing research into contemporary treatment options of the condition. These medical treatments range from bile salts, rifampicin, and opioid receptor antagonists to antihistamines. Conclusion. The burden of pruritus in liver disease patients persists and, although it is a common symptom, it can be difficult to manage. In recent years there has been greater study into the etiology and treatment of the condition. Nonetheless, pruritus remains poorly understood and many patients continue to suffer, reiterating the need for further research to improve our understanding of the etiology and treatment for the condition.

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Section: Resultsmentioning

confidence: 99%

Management of Pruritus in Chronic Liver Disease

Bhalerao

Mannu

2015

Dermatology Research and Practice

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“…15 Rodrigo Z and Joutsiniemi T have also shown statistically significant improvement in maternal pruritus after UDCA treatment as compared to placebo. 16,17 Study by Glantz A showed more itch improvement in the placebo group compared to UDCA. 20 This may be because of a small sample size.…”

Section: Discussionmentioning

confidence: 99%

“…Studies done so far, comparing UDCA with other drugs or placebos, have shown variable results, especially concerning the perinatal outcome. [15][16][17][18][19][20][21][22][23] Due to these debates in the management of patients having obstetric cholestasis we planned this study. We compared the UDCA with placebo and observed the effects on maternal symptoms of pruritus, biochemical marker i.e.…”

Section: Introductionmentioning

confidence: 99%

Obstetric Cholestasis: Comparison of Maternal and Perinatal Outcome of Ursodeoxycholic Acid versus Placebo

Safdar¹,

Kalsoom²,

Majeed³

et al. 2020

JRMC

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Objectives: Objective: To compare the maternal and perinatal outcomes of ursodeoxycholic acid with placebo in obstetric cholestasis. Method: It was an open randomized parallel-group study with convenient sampling, conducted at Pakistan ordinance factories hospital (POF Hospital) Wah Cantt, from 1st June 2016-30th May 2019. Patients with obstetric cholestasis of pregnancy, diagnosed between 24-34 weeks of gestation, were randomized to receive either ursodeoxycholic acid 500mg twice daily or placebo one capsule twice daily for 4 weeks. The data was collected on a pre-designed proforma. The data of 84 patients, who full fill the inclusion criteria were analyzed using SPSS vs 19. Maternal outcomes measured were a relief in pruritus and a decrease in hepatic alanine aminotransferase levels (ALT) at the end of 2 weeks and 4 weeks of treatment. The mode of delivery was noted. Fetal outcomes measured were meconium staining of amniotic fluid and the need for neonatal intensive care unit (NICU) admission. Results: The results showed significant improvement in maternal itch score (P=0.001) and serum transaminases level (p=0.001) in patients using UDCA as compared to placebo. Although there were less number of caesarean sections (p=0.36), meconium-stained liquor (p=0.29) and NICU admissions (P=0.33) in the UDCA group the differences were not statistically significant. Conclusion: Treatment with UDCA in obstetric cholestasis improved maternal complaint of itching and decreased raised transaminases levels but did not affect significantly the mode of delivery, incidence of meconium-stained liquor and NICU admissions. Keywords: Obstetric cholestasis, Ursodeoxycholic acid, perinatal outcome, Pruritus.

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“…UDCA appears to be the most efficient pharmacologic treatment. It has been shown that UDCA ameliorates pruritus and restores elevated liver function during ICP (Joutsiniemi et al, 2015;Joutsiniemi, Timonen, Leino, Palo, & Ekblad, 2014;Kondrackiene, Beuers, & Kupcinskas, 2005), without interfering with fetoplacental estrogen production (Joutsiniemi et al, 2014). It was more effective than cholestyramine and dexamethasone at reducing bile acid concentration (Kondrackiene et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Transport mechanism of ursodeoxycholic acid in human placental BeWo cells

Xia

Dong

Zhao

et al. 2018

Biopharm & Drug Disp

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Ursodeoxycholic acid (UDCA) is a first-line drug to treat intrahepatic cholestasis of pregnancy (ICP). However, its effects on the fetus are not clearly known. To better guide its clinical use, we aimed to study the mechanism underlying the placental transport of UDCA. The uptake and efflux of UDCA across placental apical membranes were studied using BeWo cells; effects of different exposure durations, UDCA concentrations, temperatures, and inhibitors of transporters were studied. A transwell assay was performed, and UDCA concentration in both fetal and maternal sides was measured using LC-MS/MS. Higher unidirectional transport of UDCA was observed in the basolateral-to-apical direction than in the apical-to-basolateral direction. Ko143 and verapamil, which are typical inhibitors of efflux transporters, significantly increased UDCA transport from different directions. UDCA uptake from the apical membrane of BeWo cells was time-dependent, but sodium-independent. It was inhibited by inhibitors of energy metabolism and of organic anion transporters, indicating an active transport mechanism. UDCA uptake from the apical membranes of BeWo cells could be mediated by organic anion-transporting polypeptides, whereas its efflux could be mediated by breast cancer resistance protein and multidrug resistant protein 3. The results of the present study may provide a basis for UDCA use in pregnancy.

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Ursodeoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy: a randomized controlled trial

Abstract: UDCA improves maternal itching scores and liver function tests without interfering with the fetoplacental estrogen production in patients with ICP. UDCA is well tolerated by pregnant women. No fetal or neonatal side-effects could be detected.

Cited by 37 publications

References 22 publications

Management of Pruritus in Chronic Liver Disease

Management of Pruritus in Chronic Liver Disease

Obstetric Cholestasis: Comparison of Maternal and Perinatal Outcome of Ursodeoxycholic Acid versus Placebo

Transport mechanism of ursodeoxycholic acid in human placental BeWo cells

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