Pharmacological Therapy of Pruritus in Primary Biliary Cholangitis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Abstract

GOALS:

We aim to summarize the current management of pruritus in primary biliary cholangitis (PBC) by evaluating the efficacy and safety of pharmacological therapies.

BACKGROUND:

Pruritus is a common symptom of PBC, and evidence regarding the most effective antipruritic agents available is lacking. New pharmacotherapy for PBC has shown promising antipruritic effects.

STUDY:

We performed a systematic literature review and meta-analysis including all available double-blind, randomized, placebo-controlled clinical trials that evaluated the efficacy of pharmacotherapy for the symptomatic management of pruritus in PBC. Pruritus was assessed as either a change from baseline or a postintervention score.

RESULTS:

We included 33 studies and 20 medications. Using the visual analog scale, cholestyramine did not significantly improve pruritus compared with placebo [standardized mean differences (SMD): -0.94, 95% CI: -2.05 to 0.17], whereas rifampin and nalfurafine hydrochloride both significantly improved pruritus (SMD: -3.29, 95% CI: -5.78 to -0.80; n=23 and SMD: -0.58, 95% CI: -1.04 to -0.12). In addition, Bezafibrate and linerixibat significantly improved pruritus (SMD: -1.05, 95% CI: -1.41 to -0.68; n=110 and SMD: -0.31, 95% CI: -0.62 to -0.04, respectively). This effect was also present within the subgroup analysis by pruritus scale, where both bezafibrate and linerixibat significantly improved pruritus compared with placebo (SMD: -1.09, 95% CI: -1.54 to -0.65; P <0.001; visual analog scale; as postintervention score and SMD: -0.31, 95% CI: -0.62 to -0.01; P =0.04; numeric rating scale; as a change from baseline score, respectively).

CONCLUSIONS:

Bezafibrate and Linerixibat are potential second-line antipruritic medications for PBC, particularly those with moderate to severe pruritus.

• Authors: Esli Medina-Morales, Romelia Barba Bernal, Heike Gerger, Daniela Goyes, Hirsh D Trivedi, Bryan Ferrigno, Vilas Patwardhan, Alan Bonder
• Journal: Journal of clinical gastroenterology (J Clin Gastroenterol) Vol. 57 Issue 2 Pg. 143-152 (02 01 2023) ISSN: 1539-2031 [Electronic] United States
• PMID: 36598806 (Publication Type: Systematic Review, Meta-Analysis, Journal Article)
• Copyright: Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Chemical References

• Antipruritics
• Bezafibrate

Topics

• Humans
• Liver Cirrhosis, Biliary (complications, drug therapy)
• Antipruritics (therapeutic use)
• Treatment Outcome
• Bezafibrate (therapeutic use)
• Randomized Controlled Trials as Topic
• Pruritus (drug therapy, etiology)