Long-Term Efficacy of Sertraline As A Treatment for Cholestatic Pruritus in Patients With Primary Biliary Cirrhosis

Browning, Joel; Combes, Burton; Mayo, Marlyn J.

doi:10.1111/j.1572-0241.2003.08662.x

Cited by 120 publications

(22 citation statements)

References 18 publications

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“…The selective serotonin uptake inhibitor sertraline (75-100 mg/day) can be administered as fourth-line therapy. A single placebo-controlled crossover trial [94] and a case series [95] reported moderate antipruritic effects. Coadministration of several drugs at the same time is not recommended due to the risk of drug-drug interactions.…”

Section: Managementmentioning

confidence: 99%

Advances in Pathogenesis and Management of Pruritus in Cholestasis

Kremer

Bolier

Dijk

et al. 2014

Dig Dis

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Chronic pruritus is a burdensome feature of numerous hepatobiliary disorders such as primary biliary cirrhosis, primary sclerosing cholangitis, cholangiocarcinoma, inherited forms of cholestasis and intrahepatic cholestasis of pregnancy. Bile salts, μ-opioids, serotonin, histamine and steroids have been controversially discussed in the pathogenesis of cholestatic pruritus. However, for these substances neither a correlation with itch severity nor a causative link has ever been established. Recent findings indicate that the potent neuronal activator lysophosphatidic acid and autotaxin, the enzyme forming lysophosphatidic acid, may play a key element in the pathogenesis of cholestatic pruritus. Serum activity of autotaxin correlated with itch intensity and response to antipruritic treatment in patients with cholestatic pruritus, but not other forms of pruritus. Autotaxin activity thereby represents the first biomarker for pruritus and had a positive predictive value of 70% in differentiating cholestatic pruritus from other forms of pruritus. Treatment options for patients with cholestatic pruritus include the anion exchange resin colestyramine, the PXR agonist rifampicin, the μ-opioid antagonist naltrexone, and the serotonin reuptake inhibitor sertraline. These drugs are recommended by evidence-based guidelines as a stepwise therapeutic approach. Patients unresponsive to these drugs should be referred to specialized centers to receive experimental approaches such as UVB phototherapy, albumin dialysis, plasmapheresis or nasobiliary drainage. This review discusses pruritogen candidates in cholestasis, gives novel insights into the neuronal signaling pathway of pruritus and summarizes evidence-based treatment options for patients suffering from pruritus in cholestasis.

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Section: Managementmentioning

confidence: 99%

Advances in Pathogenesis and Management of Pruritus in Cholestasis

Kremer

Bolier

Dijk

et al. 2014

Dig Dis

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“…In a retrospective study of 32 patients with pruritus due to primary biliary cirrhosis (PBC), 4 6 of 7 subjects who had been given sertraline for another indication improved considerably, and pruritus completely disappeared in 3 of those individuals. This pilot study was undertaken to find the optimal dose and to evaluate the safety and feasibility of sertraline as a possible first-line treatment of cholestatic pruritus.…”

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confidence: 99%

Sertraline as a first-line treatment for cholestatic pruritus

et al. 2007

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Pruritus is frequently the most debilitating symptom of cholestatic liver diseases. Moreover, existing therapies are often ineffective. Recent small, retrospective case series reports suggest that serotonin reuptake inhibitors can improve pruritus. This study was undertaken to establish the dose of sertraline and to evaluate its efficacy for cholestatic pruritus. Twenty one subjects with chronic pruritus due to liver disease (including primary biliary cirrhosis, primary sclerosing cholangitis, chronic hepatitis C, and postnecrotic cirrhosis) initially underwent an open-label, dose escalation to determine the dose with optimal efficacy and tolerability. After a washout period, 12 of the subjects entered a randomized, double-blind, placebo-controlled trial. Participants quantified their pruritus using a 0-10 visual analog scale, and pruritus was assessed for distribution, timing, degree of disability, and physical evidence of scratching. The optimum sertraline dose (75-100 mg/day) was well tolerated. In the controlled portion of the study, itch scores improved in patients taking sertraline, but worsened in patients taking placebo (P ‫؍‬ 0.009). Changes in itch distribution, duration, direction, and physical evidence of scratching paralleled changes in the visual analog pruritus score. Conclusion: Sertraline seems to be an effective, well-tolerated treatment for pruritus due to chronic liver disease. These results suggest that serotonergic pathways are important in the perception of itch. (HEPATOLOGY 2007;45:666-674.)

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“…4,8 The Browning trial was excluded for two reasons: inadequate patient demographics and retrospective nature of study. 1 Only primary biliary cholangitis (PBC) was included in Browning's study, while PBC, primary sclerosing cholangitis (PSC), and Hepatitis C Virus (HCV) cirrhosis were included in Mayo's study. Therefore, Mayo's study better reflects the breadth of cholestatic disease.…”

Section: Related Literaturementioning

confidence: 99%