Treatment of Primary Biliary Cholangitis with Cholestatic Pruritus
Pruritus is a characteristic cholestatic symptom in primary biliary cholangitis (PBC) that can substantially impair a patient's health-related quality of life. A stepwise treatment approach is recommended to address it systematically.
Clinical Scenario
Patient with primary biliary cholangitis presenting with cholestatic pruritus — a common and burdensome symptom in PBC that warrants structured, evidence-based management.
First-Line Treatment Approach
Current evidence-based guidance supports a specific first-line drug class as the initial intervention for pruritus in PBC. Timing of administration relative to other PBC medications is a critical consideration in this regimen.
References
DOI: 10.1002/hep.32117
- Pruritus is one of the characteristic cholestatic symptoms in PBC and results in impaired health-related quality of life (HRQoL).
- EASL recommends treating pruritus using a step wise approach.
- Given its favourable safety profile, EASL recommends cholestyramine as the first-line therapy for pruritus, despite its limitations.
- Bile sequestrants must be given 2–4 h before or after other medications (including UDCA or OCA) as they interfere with intestinal absorption.