Practical strategies for pruritus management in the obeticholic acid-treated patient with PBC

Proceedings from the 2018 expert panel

Jennifer Pate, Juilo A. Gutierrez, Catherine T. Frenette, Aparna Goel, Sonal Kumar, Richard A. Manch, Edward A. Mena, Paul J. Pockros, Sanjaya Satapathy, Kidist K. Yimam, Robert G. Gish

Research output: Contribution to journalArticle

Abstract

Background and aims This article provides expert guidance on the management of pruritus symptoms in patients receiving obeticholic acid (OCA) as treatment for primary biliary cholangitis (PBC). PBC is a chronic, autoimmune cholestatic liver disease that affects intrahepatic bile ducts. If not adequately treated, PBC can lead to cholestasis and end-stage liver disease, which may require transplant. Timely treatment is therefore vital to patient health. Pruritus is a common symptom in patients with PBC. Additionally, the use of OCA to treat PBC can contribute to increased pruritus severity in some patients, adding to patient discomfort, decreasing patient quality of life (QoL), and potentially affecting patient adherence to OCA treatment. Methods In May 2018, a group of physician experts from the fields of gastroenterology, hepatology, and psychiatry met to discuss the management of pruritus in OCA-treated patients with PBC. Recognizing the importance of optimizing treatment for PBC, these experts developed recommendations for managing pruritus symptoms in the OCA-treated PBC patient based on their experience in clinical practice. Results These recommendations include a comprehensive list of management strategies (including over-the-counter, prescription, and alternative therapies), guidance on titration of OCA to minimize pruritus severity, and an algorithm that outlines a practical approach to follow up with patients receiving OCA, to better assess and manage pruritus symptoms. Conclusions Pruritus associated with OCA therapy is dose dependent and often manageable, and with the proper education and tools, most pruritus cases can be effectively managed to minimize treatment discontinuation.

Original languageEnglish (US)
Article numbere000256
JournalBMJ Open Gastroenterology
Volume6
Issue number1
DOIs
StatePublished - Feb 1 2019

Fingerprint

Cholangitis
Pruritus
Gastroenterology
Therapeutics
Intrahepatic Bile Ducts
6-ethylchenodeoxycholic acid
End Stage Liver Disease
Cholestasis
Patient Compliance
Complementary Therapies
Prescriptions
Psychiatry
Liver Diseases
Quality of Life
Physicians
Transplants
Education
Health

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

Practical strategies for pruritus management in the obeticholic acid-treated patient with PBC : Proceedings from the 2018 expert panel. / Pate, Jennifer; Gutierrez, Juilo A.; Frenette, Catherine T.; Goel, Aparna; Kumar, Sonal; Manch, Richard A.; Mena, Edward A.; Pockros, Paul J.; Satapathy, Sanjaya; Yimam, Kidist K.; Gish, Robert G.

In: BMJ Open Gastroenterology, Vol. 6, No. 1, e000256, 01.02.2019.

Research output: Contribution to journalArticle

Pate, J, Gutierrez, JA, Frenette, CT, Goel, A, Kumar, S, Manch, RA, Mena, EA, Pockros, PJ, Satapathy, S, Yimam, KK & Gish, RG 2019, 'Practical strategies for pruritus management in the obeticholic acid-treated patient with PBC: Proceedings from the 2018 expert panel', BMJ Open Gastroenterology, vol. 6, no. 1, e000256. https://doi.org/10.1136/bmjgast-2018-000256
Pate, Jennifer ; Gutierrez, Juilo A. ; Frenette, Catherine T. ; Goel, Aparna ; Kumar, Sonal ; Manch, Richard A. ; Mena, Edward A. ; Pockros, Paul J. ; Satapathy, Sanjaya ; Yimam, Kidist K. ; Gish, Robert G. / Practical strategies for pruritus management in the obeticholic acid-treated patient with PBC : Proceedings from the 2018 expert panel. In: BMJ Open Gastroenterology. 2019 ; Vol. 6, No. 1.
@article{a161ae31231947978b7d33bbcf434ad4,
title = "Practical strategies for pruritus management in the obeticholic acid-treated patient with PBC: Proceedings from the 2018 expert panel",
abstract = "Background and aims This article provides expert guidance on the management of pruritus symptoms in patients receiving obeticholic acid (OCA) as treatment for primary biliary cholangitis (PBC). PBC is a chronic, autoimmune cholestatic liver disease that affects intrahepatic bile ducts. If not adequately treated, PBC can lead to cholestasis and end-stage liver disease, which may require transplant. Timely treatment is therefore vital to patient health. Pruritus is a common symptom in patients with PBC. Additionally, the use of OCA to treat PBC can contribute to increased pruritus severity in some patients, adding to patient discomfort, decreasing patient quality of life (QoL), and potentially affecting patient adherence to OCA treatment. Methods In May 2018, a group of physician experts from the fields of gastroenterology, hepatology, and psychiatry met to discuss the management of pruritus in OCA-treated patients with PBC. Recognizing the importance of optimizing treatment for PBC, these experts developed recommendations for managing pruritus symptoms in the OCA-treated PBC patient based on their experience in clinical practice. Results These recommendations include a comprehensive list of management strategies (including over-the-counter, prescription, and alternative therapies), guidance on titration of OCA to minimize pruritus severity, and an algorithm that outlines a practical approach to follow up with patients receiving OCA, to better assess and manage pruritus symptoms. Conclusions Pruritus associated with OCA therapy is dose dependent and often manageable, and with the proper education and tools, most pruritus cases can be effectively managed to minimize treatment discontinuation.",
author = "Jennifer Pate and Gutierrez, {Juilo A.} and Frenette, {Catherine T.} and Aparna Goel and Sonal Kumar and Manch, {Richard A.} and Mena, {Edward A.} and Pockros, {Paul J.} and Sanjaya Satapathy and Yimam, {Kidist K.} and Gish, {Robert G.}",
year = "2019",
month = "2",
day = "1",
doi = "10.1136/bmjgast-2018-000256",
language = "English (US)",
volume = "6",
journal = "BMJ Open Gastroenterology",
issn = "2054-4774",
publisher = "BMJ Publishing Group",
number = "1",

}

TY - JOUR

T1 - Practical strategies for pruritus management in the obeticholic acid-treated patient with PBC

T2 - Proceedings from the 2018 expert panel

AU - Pate, Jennifer

AU - Gutierrez, Juilo A.

AU - Frenette, Catherine T.

AU - Goel, Aparna

AU - Kumar, Sonal

AU - Manch, Richard A.

AU - Mena, Edward A.

AU - Pockros, Paul J.

AU - Satapathy, Sanjaya

AU - Yimam, Kidist K.

AU - Gish, Robert G.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Background and aims This article provides expert guidance on the management of pruritus symptoms in patients receiving obeticholic acid (OCA) as treatment for primary biliary cholangitis (PBC). PBC is a chronic, autoimmune cholestatic liver disease that affects intrahepatic bile ducts. If not adequately treated, PBC can lead to cholestasis and end-stage liver disease, which may require transplant. Timely treatment is therefore vital to patient health. Pruritus is a common symptom in patients with PBC. Additionally, the use of OCA to treat PBC can contribute to increased pruritus severity in some patients, adding to patient discomfort, decreasing patient quality of life (QoL), and potentially affecting patient adherence to OCA treatment. Methods In May 2018, a group of physician experts from the fields of gastroenterology, hepatology, and psychiatry met to discuss the management of pruritus in OCA-treated patients with PBC. Recognizing the importance of optimizing treatment for PBC, these experts developed recommendations for managing pruritus symptoms in the OCA-treated PBC patient based on their experience in clinical practice. Results These recommendations include a comprehensive list of management strategies (including over-the-counter, prescription, and alternative therapies), guidance on titration of OCA to minimize pruritus severity, and an algorithm that outlines a practical approach to follow up with patients receiving OCA, to better assess and manage pruritus symptoms. Conclusions Pruritus associated with OCA therapy is dose dependent and often manageable, and with the proper education and tools, most pruritus cases can be effectively managed to minimize treatment discontinuation.

AB - Background and aims This article provides expert guidance on the management of pruritus symptoms in patients receiving obeticholic acid (OCA) as treatment for primary biliary cholangitis (PBC). PBC is a chronic, autoimmune cholestatic liver disease that affects intrahepatic bile ducts. If not adequately treated, PBC can lead to cholestasis and end-stage liver disease, which may require transplant. Timely treatment is therefore vital to patient health. Pruritus is a common symptom in patients with PBC. Additionally, the use of OCA to treat PBC can contribute to increased pruritus severity in some patients, adding to patient discomfort, decreasing patient quality of life (QoL), and potentially affecting patient adherence to OCA treatment. Methods In May 2018, a group of physician experts from the fields of gastroenterology, hepatology, and psychiatry met to discuss the management of pruritus in OCA-treated patients with PBC. Recognizing the importance of optimizing treatment for PBC, these experts developed recommendations for managing pruritus symptoms in the OCA-treated PBC patient based on their experience in clinical practice. Results These recommendations include a comprehensive list of management strategies (including over-the-counter, prescription, and alternative therapies), guidance on titration of OCA to minimize pruritus severity, and an algorithm that outlines a practical approach to follow up with patients receiving OCA, to better assess and manage pruritus symptoms. Conclusions Pruritus associated with OCA therapy is dose dependent and often manageable, and with the proper education and tools, most pruritus cases can be effectively managed to minimize treatment discontinuation.

UR - http://www.scopus.com/inward/record.url?scp=85061107592&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85061107592&partnerID=8YFLogxK

U2 - 10.1136/bmjgast-2018-000256

DO - 10.1136/bmjgast-2018-000256

M3 - Article

VL - 6

JO - BMJ Open Gastroenterology

JF - BMJ Open Gastroenterology

SN - 2054-4774

IS - 1

M1 - e000256

ER -