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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(1):e000256doi: 10.1136/bmjgast-2018-000256.
Pate, J., Gutierrez, J. A., Frenette, C. T., Goel, A., Kumar, S., Manch, R. A., Mena, E. A., Pockros, P. J., Satapathy, S. K., Yimam, K. K., & Gish, R. G. (2019). Practical strategies for pruritus management in the obeticholic acid-treated patient with PBC: proceedings from the 2018 expert panel. BMJ open gastroenterology, 6(1), e000256. https://doi.org/10.1136/bmjgast-2018-000256
Pate, Jennifer, et al. "Practical strategies for pruritus management in the obeticholic acid-treated patient with PBC: proceedings from the 2018 expert panel." BMJ open gastroenterology vol. 6,1 (2019): e000256. doi: https://doi.org/10.1136/bmjgast-2018-000256
Pate J, Gutierrez JA, Frenette CT, Goel A, Kumar S, Manch RA, Mena EA, Pockros PJ, Satapathy SK, Yimam KK, Gish RG. Practical strategies for pruritus management in the obeticholic acid-treated patient with PBC: proceedings from the 2018 expert panel. BMJ Open Gastroenterol. 2019 Feb 01;6(1):e000256. doi: 10.1136/bmjgast-2018-000256. eCollection 2019. PMID: 30815273; PMCID: PMC6361341.
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BMJ Open Gastroenterol. 2019 Feb 01;6(1):e000256. doi: 10.1136/bmjgast-2018-000256. eCollection 2019.

Practical strategies for pruritus management in the obeticholic acid-treated patient with PBC: proceedings from the 2018 expert panel.

BMJ open gastroenterology

Jennifer Pate, Juilo A Gutierrez, Catherine T Frenette, Aparna Goel, Sonal Kumar, Richard A Manch, Edward A Mena, Paul J Pockros, Sanjaya K Satapathy, Kidist K Yimam, Robert G Gish

Affiliations

  1. Baylor St Luke's Medical Center, Houston, Texas, USA.
  2. Transplant and Hepatopancreatobiliary Institute, Verity Medical Foundation, San Jose, California, USA.
  3. Division of Organ Transplantation, Scripps Clinic/Scripps Green Hospital, La Jolla, California, USA.
  4. Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
  5. Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York City, New York, USA.
  6. Institute for Liver Health, Phoenix, Arizona, USA.
  7. Pasadena Liver Center, Pasadena, California, USA.
  8. Division of Gastroenterology and Hepatology, Scripps Clinic/Scripps Translational Science Institute, La Jolla, California, USA.
  9. Division of Transplant Surgery, Methodist University Hospital Transplant Institute, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
  10. Autoimmune Liver Disease Program, California Pacific Medical Center, San Francisco, California, USA.

PMID: 30815273 PMCID: PMC6361341 DOI: 10.1136/bmjgast-2018-000256

Abstract

BACKGROUND AND AIMS: This article provides expert guidance on the management of pruritus symptoms in patients receiving obeticholic acid (OCA) as treatment for primary biliary cholangitis (PBC). PBC is a chronic, autoimmune cholestatic liver disease that affects intrahepatic bile ducts. If not adequately treated, PBC can lead to cholestasis and end-stage liver disease, which may require transplant. Timely treatment is therefore vital to patient health. Pruritus is a common symptom in patients with PBC. Additionally, the use of OCA to treat PBC can contribute to increased pruritus severity in some patients, adding to patient discomfort, decreasing patient quality of life (QoL), and potentially affecting patient adherence to OCA treatment.

METHODS: In May 2018, a group of physician experts from the fields of gastroenterology, hepatology, and psychiatry met to discuss the management of pruritus in OCA-treated patients with PBC. Recognizing the importance of optimizing treatment for PBC, these experts developed recommendations for managing pruritus symptoms in the OCA-treated PBC patient based on their experience in clinical practice.

RESULTS: These recommendations include a comprehensive list of management strategies (including over-the-counter, prescription, and alternative therapies), guidance on titration of OCA to minimize pruritus severity, and an algorithm that outlines a practical approach to follow up with patients receiving OCA, to better assess and manage pruritus symptoms.

CONCLUSIONS: Pruritus associated with OCA therapy is dose dependent and often manageable, and with the proper education and tools, most pruritus cases can be effectively managed to minimize treatment discontinuation.

Keywords: cholestatic liver disease; liver; obeticholic acid; primary biliary cholangitis; pruritus

Conflict of interest statement

Competing interests: JP received honoraria as an advisory board member from Intercept Pharmaceuticals and served on the speaker’s bureau for Intercept Pharmaceuticals. JAG received honoraria as an adv

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