What treatments have you found most effective for cholestatic pruritus?

I have a patient with recently diagnosed primary biliary cholangitis/cirrhosis (PBC) with SSc. Her laboratory values are within normal limits, but endorses pruritus that breaks through despite cholestyramine and ursodiol. Any other recommendations? Potential JAK/STAT inhibitors?

1 Answer

Mednet MemberInvited Expert

Rheumatology · University of California, Berkeley and San Francisco

Answered on

My experience is mainly in Sjogren's or Sjogren's with PBC, ursodiol has been effective. Occasionally, I have used hydroxyzine or H1+H2 blockers. In Sjogren's where the skin biopsy has shown significant lymphocytic infiltration, mycophenolate or a calcineurin inhibitor trial has lead to the resolution of pruritus. There are reports of rifampin and naltrexone being beneficial, but I have not used them.

In the setting of SSc with PBC, is it possible that skin fibrosis is affecting itch-sensing nerves? I don't know if JAKi or other immune modulators are potentially beneficial. Hope others weigh in.