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DOI: 10.1055/s-0036-1586975
Effects of plasmapheresis on refractory cholestatic pruritus in patients with PBC: prospective analysis of 129 procedures
Introduction: The amelioration of refractory cholestatic pruritus after plasmapheresis has been reported in single cases. Here we analyse the efficacy of plasmapheresis in decreasing itch in patients with primary biliary cholangitis (PBC) who did not respond to pharmacological treatment.
Patients and methods: Seventeen consecutive patients with PBC (age 61 ± 10.6 years, 16 women, 9 patients with cirrhosis) were recruited and underwent in total 129 plasmapharesis procedures during 40 admissions. All patients had not responded to systemic therapy with cholestyramine (1st line) and rifampine (2nd line) before the start of plasmapheresis. Pruritus was quantified with the 10 point visual analogue scale (VAS) before, immediately after plasmapheresis, as well as 30 and 90 days later.
Results: Plasmaphereses decreased itching to ≤5 in all but 3 admissions. Median pruritus decreased from 8.0 (range 5 – 10) to 3.0 (range 0 – 9) (P < 0.0001). Plasmapheresis caused a significant improvement of serum ALT, ALP, AST and GGT activities (all P < 0.0001) as well as bilirubin concentrations (P = 0.002). Antipruritic effect persisted throughout the 90 day-follow up (P < 0.0001) but on day 90, we detected a significant rebound of itch (P = 0.04). These results were not affected by the presence of cirrhosis (P > 0.05).
Conclusions: Plasmapheresis is a potent and safe method of reducing intractable itch in a significant proportion of patients with PBC and does not depend on the stage of fibrosis. Long-lasting improvement of symptoms requires repeat procedures.