Treatment of Pruritus Secondary to Liver Disease

Current Gastroenterology Reports
Miriam M Düll, Andreas E Kremer

Abstract

Pruritus is a common extrahepatic symptom in various liver disorders, in particularly those with cholestatic features. This review summarizes epidemiology, pathophysiology, evidence-based therapeutic recommendations and currently investigated drugs for pruritus in hepatobiliary disorders. Recent epidemiological data suggest pruritus as a common and relevant symptom in immune-mediated liver diseases, i.e., primary biliary cholangitis (PBC) with over 70% affected patients, up to 56% suffering from chronic pruritus. The better pathophysiological understanding of hepatic pruritus has led to the identification of novel therapeutic targets, addressed in drug trials using KOR agonists, PPAR agonists, and ileal bile acid transporter inhibitors. Hepatic itch remains among the most agonizing symptoms for affected patients and a clinical challenge for physicians. Therapeutic recommendations include a guideline-based stepwise approach starting with cholestyramine, followed by rifampicin, naltrexone, and sertraline. Bezafibrate and ileal bile acid transporter inhibitors represent promising future anti-pruritic treatment options.

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Citations

May 30, 2020·Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete·T Mettang, A E Kremer
Feb 18, 2021·Pharmacological Reports : PR·Jin-Yu YangDong Liu
Apr 11, 2021·Expert Opinion on Drug Safety·Juan Trivella, Cynthia Levy
Jul 25, 2021·International Journal of Molecular Sciences·Qiaojuan ZhangYong Chen
Aug 18, 2021·Liver International : Official Journal of the International Association for the Study of the Liver·Andreas E KremerYun-Jung Choi
Dec 8, 2021·Best Practice & Research. Clinical Gastroenterology·André Jefremow, Markus F Neurath

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