Cholestatic Pruritus

CME

The Impact of Cholestatic Pruritus in PBC

Physicians: Maximum of 0.75 AMA PRA Category 1 Credit

Released: June 18, 2024

Expiration: June 17, 2025

Christopher L. Bowlus
Christopher L. Bowlus, MD

Activity

Progress
1 2
Course Completed

References

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  2. Deng X, Li J, Hou S, et al. Prevalence and impact of Sjögren’s syndrome in primary biliary cholangitis: a systematic review and meta-analysis. Ann Hepatol. 2022;27:100746.
  3. Lindor KD, Bowlus CL, Boyer J, et al. Primary biliary cholangitis: 2018 practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2019;69:394-419.
  4. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: the diagnosis and management of patients with primary biliary cholangitis. J Hepatol. 2017;67:145-172.
  5. Rigopoulou EI, Davies ET, Pares A, et al. Prevalence and clinical significance of isotype specific antinuclear antibodies in primary biliary cirrhosis. Gut. 2005;54:528-532.  
  6. Bunchorntavakul C, Reddy KR. Pruritus in chronic cholestatic liver disease. Clin Liver Dis. 2012;16:331-346.
  7. Kamath BM, Baker A, Houwen R, et al. Systematic review: the epidemiology, natural history, and burden of Alagille syndrome. J Pediatr Gastroenterol Nutr. 2018;67:148-156.
  8. Kode V, Yimam KK. Cholestatic pruritus: pathophysiology, current management approach, and emerging therapies. Curr Hepatol Rep. 2024;23:123-136.
  9. Imam MH, Gossard AA, Sinakos E, et al. Pathogenesis and management of pruritus in cholestatic liver disease. J Gastroenterol Hepatol. 2012;27:1150-1158.
  10. Beuers U, Wolters F, Oude Elferink RPJ. Mechanisms of pruritus in cholestasis: understanding and treating the itch. Nat Rev Gastroenterol Hepatol. 2023;20:26-36.
  11. Smith H. More than just an itch: impact of cholestatic pruritus in primary biliary cholangitis (PBC) on health-related quality of life (HRQoL). Presented at: 2022 EASL International Liver Congress; June 22-26, 2022. Poster 1916.
  12. Hirschfield G, Lleo A, Jones D, et al. Holistic patient care in primary biliary cholangitis: managing both the disease and the symptoms. EMJ Hepatol. 2022;10:22-31. 
  13. Tey HL, Wallengren J, Yosipovitch G. Psychosomatic factors in pruritus. Clin Dermatol. 2013;31:31-40.
  14. Mayo MJ, Carey E, Smith HT, et al; TARGET-PBC Investigators; Levy C. Impact of pruritus on quality of life and current treatment patterns in patients with primary biliary cholangitis. Dig Dis Sci. 2023;68:995-1005.
  15. Abbas N, Smith R, Flack S, et al; UK-PBC audit group. Critical shortfalls in the management of PBC: results of a UK-wide, population-based evaluation of care delivery. JHEP Rep. 2023;6:100931.
  16. Dyson JK, Wilkinson N, Jopson L, et al. The inter-relationship of symptom severity and quality of life in 2055 patients with primary biliary cholangitis. Aliment Pharmacol Ther. 2016;44:1039-1050.
  17. Mitchell C, Eddy A, Neuberger J, et al. P13 Patient experience of primary biliary cholangitis (PBC) symptom evaluation and management in clinical appointments and pathways compared to The British Society of Gastroenterology (BSG)/UK-PBC PBC treatment and management guidelines: results from PBC Foundation mobile app patient survey. Gut. 2022;71:A39-A41.
  18. Fujino H, Tanaka M, Imamura M, et al. Pruritus in patients with chronic liver disease and serum autotaxin levels in patients with primary biliary cholangitis. BMC Gastroenterol. 2019;19:169.
  19. Düll MM, Kremer AE. Evaluation and management of pruritus in primary biliary cholangitis. Clin Liver Dis. 2022;26:727-774.
  20. Kwatra SG, Rodriguez D, Dias-Barbosa C, et al. Validation of the Peak Pruritus Numerical Rating Scale as a patient-reported outcome measure in prurigo nodularis. Dermatol Ther (Heidelb). 2023;13:2403-2416. ​
  21. Elman S, Hynan LS, Gabriel V, et al. The 5-D itch scale: a new measure of pruritus. Br J Dermatol. 2010;162:587-593.
  22. Pate J, Gutierrez JA, Frenette CT, et al. Practical strategies for pruritus management in the obeticholic acid-treated patient with PBC: proceedings from the 2018 expert panel. BMJ Open Gastroenterol. 2019;6:e000256.​
  23. Patel SP, Vasavda C, Ho B, et al. Cholestatic pruritus: emerging mechanisms and therapeutics. J Am Acad Dermatol. 2019;81:1371-1378.
  24. Cholestyramine [prescribing information]. Chestnut Ridge, NY: Par Pharmaceutical; 2022.
  25. Colesevelam [prescribing information]. Basking Ridge, NJ: Daiichi Sankyo; 2019.
  26. Colestipol [prescribing information]. New York, NY: Pfizer; 2023.
  27. Rifampin [prescribing information]. Bridgewater, NJ: Sanofi-Aventis U.S.; 2022.
  28. Naltrexone [prescribing information]. Waltham, MA: Alkermes; 2022.
  29. Colapietro F, Gershwin ME, Lleo A. PPAR agonists for the treatment of primary biliary cholangitis: old and new tales. J Transl Autoimmun. 2023;6:100188.
  30. Kowdley KV, Bowlus CL, Levy C, et al; ELATIVE Study Investigators’ Group; ELATIVE Study Investigators' Group. Efficacy and safety of elafibranor in primary biliary cholangitis. N Engl J Med. 2024;390:795-805.​
  31. Hirschfield GM, Shiffman ML, Gulamhusein A, et al. Seladelpar efficacy and safety at 3 months in patients with primary biliary cholangitis: ENHANCE, a phase 3, randomized, placebo-controlled study. Hepatology. 2023;78:397-415.
  32. Hirschfield GM, Bowlus CL, Mayo MJ, et al. A Phase 3 Trial of Seladelpar in Primary Biliary Cholangitis. N Engl J Med. 2024;390:783-794.
  33. de Vries E, Bolier R, Goet J, et al; Netherlands Association for the Study of the Liver-Cholestasis Working Group. Fibrates for Itch (FITCH) in fibrosing cholangiopathies: a double-blind, randomized, placebo-controlled trial. Gastroenterology. 2021;160:734-743.e6.
  34. MedicineNet. Bezafibrate. medicinenet.com/bezafibrate/article.htm. Accessed June 3, 2024. ​
  35. Maralixibat [prescribing information]. Foster City, CA: Mirum Pharmaceuticals; 2024.
  36. Odevixibat [prescribing information]. Cambridge, MA: Ipsen Biopharmaceuticals; 2024.
  37. Levy C, Kendrick S, Bowlus CL, et al; GLIMMER Study Group. GLIMMER: a randomized phase 2b dose-ranging trial of linerixibat in primary biliary cholangitis patients with pruritus. Clin Gastroenterol Hepatol. 2023;21:1902-1912.e13.