‘Out‐patient’ albumin dialysis for cholestatic patients with intractable pruritus

Leckie, P; Tritto, Giovanni; Mookerjee, Rajeshwar P.; Davies, Nathan; Jones, David; Jalan, Rajiv

doi:10.1111/j.1365-2036.2012.04994.x

Cited by 45 publications

(31 citation statements)

References 32 publications

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“…118,119 Clinical observations suggest that pruritogens accumulate in the systemic circulation; severe pruritus is at least in part relieved after treatment with plasmapheresis, albumin dialysis (for example MARS®, Gambro, Sweden) or plasma separation and anion absorption. 120,121 They are also secreted into bile-pruritus can be attenuated after oral administration of the anion exchange resin cholestyramine, 122,123 or in the most severe cases, transiently relieved after nasobiliary drainage. 124 Owing to these observations, trials of ileal apical sodium bile-acid transporter inhibitors are currently undergoing phase II evaluation, including LUM001 (NCT01904058 125 ) and GSK2330672 (NCT01899703 126 ).…”

Section: Targeting Pruritusmentioning

confidence: 99%

Novel therapeutic targets in primary biliary cirrhosis

Dyson

Hirschfield

Adams

et al. 2015

Nat Rev Gastroenterol Hepatol

112

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Primary biliary cirrhosis (PBC) is a chronic immune-mediated liver disease characterized by progressive cholestasis, biliary fibrosis and eventually cirrhosis. It results in characteristic symptoms with marked effects on life quality. The advent of large patient cohorts has challenged the view of PBC as a benign condition treated effectively by the single licensed therapy-ursodeoxycholic acid (UDCA). UDCA nonresponse or under-response has a major bearing on outcome, substantially increasing the likelihood that liver transplantation will be required or that patients will die of the disease. In patients with high-risk, treatment-unresponsive or highly symptomatic disease the need for new treatment approaches is clear. Evolution in our understanding of disease mechanisms is rapidly leading to the advent of new and re-purposed therapeutic agents targeting key processes. Notable opportunities are offered by targeting what could be considered as the 'upstream' immune response, 'midstream' biliary injury and 'downstream' fibrotic processes. Combination therapy targeting several pathways or the development of novel agents addressing multiple components of the disease pathway might be required. Ultimately, PBC therapeutics will require a stratified approach to be adopted in practice. This Review provides a current perspective on potential approaches to PBC treatment, and highlights the challenges faced in evaluating and implementing those treatments.

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Section: Targeting Pruritusmentioning

confidence: 99%

Novel therapeutic targets in primary biliary cirrhosis

Dyson

Hirschfield

Adams

et al. 2015

Nat Rev Gastroenterol Hepatol

112

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“…Previous studies have shown improvement in hepatic encephalopathy [10]. Improvements in quality of life have been demonstrated in patients with intractable pruritus listed for transplantation [6], thus impacting on the availability of organs.…”

Section: Artificial Liver Support Devicesmentioning

confidence: 99%

“…Thus far, the available devices have failed to show any impact on survival, although there have been improvements in quality of life, e.g. control of intractable pruritus [6], and there may be an economical benefit to some devices by reducing length of hospitalisation.…”

Section: Rationale For Use Of Liver Supportmentioning

confidence: 99%

Extracorporeal Liver Support

2012

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Mortality of patients with liver failure remains unacceptably high. As the liver has an enormous potential to regenerate, extracorporeal liver support devices may allow patients with liver failure to be bridged to recovery. Alternatively, liver assist may allow patients with advanced liver disease to be managed until a suitable organ for transplant is available. Current approaches to liver support include the use of biological devices that contain hepatocytes and those that function as detoxification devices, and artificial liver support systems. This review describes the current state of the art and existing data on the use of these devices to treat patients with liver failure.

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“…Albumin dialysis (molecular adsorbent recirculating system) using an adsorbent recirculating circuit is thought to exert its antipruritic effects by removing pruritogens from the circulation. 86 In a study of 20 patients with cholestatic pruritus who underwent albumin dialysis, a significant improvement in pruritus as defined by visual analogue scale (scores decreased from 70. In patients with PBC, inhibition of IBAT by GSK2330672 was anticipated to increase excretion of BAs and reduce BA concentrations in the liver and systemic circulation, resulting in reduced pruritus and associated symptoms.…”

Section: Management Of Itch In Pbcmentioning

confidence: 99%

Novel strategies and therapeutic options for the management of primary biliary cholangitis

Khanna

Jones

2017

Therap Adv Gastroenterol

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Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease. It has a varied course of progression ranging from being completely asymptomatic to aggressive disease leading to cirrhosis and resulting in liver transplantation. In addition, symptoms can be debilitating and can have a major impact on quality of life. For decades, there was only one anti-cholestatic agent available to target this disease and that was only effective in around half of patients, with little or no effect on symptoms. With increasing understanding of the pathogenic mechanisms of PBC and potential targets for drug treatment, pharmaceutical companies have shown a greater interest in this rare disease. A large number of novel therapeutic molecules have been developed and are currently being evaluated. In this review article all the novel molecules in use and in trials targeting cholestasis and symptoms in PBC are discussed.

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‘Out‐patient’ albumin dialysis for cholestatic patients with intractable pruritus

Abstract: SUMMARY BackgroundIntractable pruritus is a major problem for some patients with cholestasis. Albumin dialysis has been shown to ameliorate pruritus, but long-term outcome data are limited.

Cited by 45 publications

References 32 publications

Novel therapeutic targets in primary biliary cirrhosis

Novel therapeutic targets in primary biliary cirrhosis

Extracorporeal Liver Support

Novel strategies and therapeutic options for the management of primary biliary cholangitis

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