Treatment of Primary Biliary Cholangitis with Cholestatic Pruritus

Cholestatic pruritus is a hallmark symptom of primary biliary cholangitis (PBC) with a well-documented negative impact on health-related quality of life. Current guidance calls for a stepwise approach to its management, with escalation when earlier options prove insufficient.

Clinical Scenario

This protocol applies to patients with primary biliary cholangitis who present with cholestatic pruritus. Pruritus is among the characteristic cholestatic symptoms of PBC and significantly impairs health-related quality of life (HRQoL).

Treatment Approach

For patients whose pruritus has not responded to other agents, empirical use of selective serotonin reuptake inhibitors (SSRIs) is among the options considered at this stage of management. The complete protocol specifies which agents apply, how they are selected, and the full stepwise algorithm.

Instant Access to Structured Evidence-Based Regimens

References

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.
Selective serotonin reuptake inhibitors (SSRIs; e.g. sertraline) and gabapentin are used empirically in the management of cholestatic itch, typically in patients with pruritus unresponsive to other agents.

DOI: 10.1002/hep.32117

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