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Treatment strategies of itch

Andreas E. Kremer 1

Affiliations

1 University Hospital Zürich, Zürich, Switzerland

Summary

AI Generated

The speaker presented current and future treatment strategies for cholestatic pruritus, emphasizing a stepwise approach from topical care through PPAR agonists to investigational therapies and invasive procedures for refractory cases.

The speaker stated that bezafibrate is now considered equally first-line therapy for pruritus in PBC and PSC patients and is way more efficacious than cholestyramine, with roughly 50% of patients achieving 50% itch reduction in a three-week trial at 400mg daily.
The speaker reported that odevixibat and maralixibat, IBAT inhibitors that block bile acid reuptake in the terminal ileum, have been licensed by EMA and FDA to treat pruritus in progressive familial intrahepatic cholestasis and Alagille syndrome based on six-month pediatric trials showing significant itch and bile acid reduction.
The speaker stated that seladelpar, a delta-selective PPAR agonist, showed sustained separation in pruritus scores over one year in PBC patients with moderate to severe pruritus as a secondary endpoint in a New England Journal publication this year.
The speaker recommended gabapentin and pregabalin as additional treatment options, noting that while a small published trial was negative, retrospective data from the speaker's group showed a 5.8-point reduction, which the speaker considers suitable add-on therapy with dose titration.
The speaker emphasized that good skincare with emollients, UV phototherapy at 50% minimal erythema dose two to three times weekly, and cooling measures significantly improve symptom burden and should not be forgotten in the treatment algorithm.
The speaker stated that invasive procedures including albumin dialysis, plasma exchange, and nasobiliary drainage can improve pruritus but should be reserved for exceptional refractory cases at referral centers, with nasobiliary drainage showing significant but short-lasting benefit despite considerable procedural risk.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Event

UEG Postgraduate Teaching Programme Vienna 2024

Topics

Education & Training Hepatobiliary Neurogastroenterology & Motility Primary Care

Session

How to treat itching?

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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BURNOUT SYNDROME ASSESSMENT OF NURSING STAFF IN A DIGESTIVE ENDOSCOPY UNIT AT A TERTIARY REFERRAL HOSPITAL

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