Primary sclerosing cholangitis
ICD-10 K83.0 · ICD-11 DB96.2

PSC with Moderate-to-Severe Pruritus: Treatment After Bezafibrate Has Not Provided Significant Relief

This protocol addresses patients with large duct primary sclerosing cholangitis who experience moderate to severe pruritus (skin itching) and have not achieved significant improvement of itch complaints on first-line pharmacological treatment with bezafibrate.

Clinical Scenario

Moderate to severe pruritus is a significant burden in large duct sclerosing cholangitis. Relevant bile duct strictures should be excluded as a cause of progressive pruritus before escalating pharmacological therapy. Pharmacological treatment of moderate to severe pruritus in sclerosing cholangitis is recommended.

Previous Treatment — Criteria for Escalation

First-line pharmacological treatment with bezafibrate did not result in significant improvement of moderate to severe itch complaints. This failure of the first-line approach is the criterion that defines this next-step protocol.

Next-Line Approach (Partial Overview)

A second-line pharmacological agent is indicated. The full protocol specifies the agent and its evidence base — including relevant safety considerations that must inform monitoring decisions. Access the complete regimen below.

Instant Access to Structured Evidence-Based Regimens

References

Pharmacological treatment of moderate to severe pruritus in sclerosing cholangitis with bezafibrate or rifampicin is recommended.

It is recommended to exclude relevant bile duct strictures in large duct sclerosing cholangitis as the cause of progressive pruritus.

Rifampicin was so far regarded as the most effective evidence-based treatment of cholestasis-associated pruritus, but it may induce drug-induced hepatitis after 4–12 weeks in up to 12% of cholestatic patients while the first 2 weeks are regarded as safe.

DOI: 10.1016/j.jhep.2022.05.011

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