Plasmapheresis exerts a long‐lasting antipruritic effect in severe cholestatic itch. (17th November 2016)

• Record Type: Journal Article
• Authors: Krawczyk, Marcin; Liebe, Roman; Wasilewicz, Michał; Wunsch, Ewa; Raszeja‐Wyszomirska, Joanna; Milkiewicz, Piotr
• Is Part Of: Liver international. Volume 37:Number 5(2017)
• Page Start: 743
• Page End: 747
• Publication Date: 2016-11-17
• Subjects: Cholestasis -- cirrhosis -- itch -- rifampicin; Liver -- Periodicals; Liver -- Diseases -- Periodicals; 616.362
• DOI: 10.1111/liv.13281
• Languages: English
• ISSNs: 1478-3223

Abstract

Abstract: Background & Aims: The amelioration of refractory cholestatic pruritus after plasmapheresis has been reported in single patients. Here, we analyse the efficacy of plasmapheresis in a cohort of patients with primary biliary cholangitis (PBC). Methods: Seventeen consecutive patients with PBC (age range 39‐85 years, 16 females, 9 with cirrhosis) and refractory pruritus underwent 129 plasmapheresis procedures during 40 admissions. Pruritus was quantified by the 10‐point numeric rating scale (NRS) before and after plasmapheresis, as well as ~30 and ~90 days later. Results: The mean pruritus before plasmapheresis did not differ between patients with and without cirrhosis ( P >.05). Cirrhotics presented, however, with significantly higher serum alanine aminotransferase (ALT), aspartate transaminase (AST), gamma‐glutamyl transpeptidase (GGT), alkaline phosphatase (ALP) and bilirubin before plasmapheresis. Plasmapheresis decreased itching to NRS≤5 in all but five admissions: Mean pruritus decreased from 8.3±1.4 to 3.1±2.2 ( P <.0001) in the entire cohort. It also led to a significant decrease in serum ALT, ALP, AST, GGT (all P <.001) and bilirubin ( P =.002). Antipruritic effect persisted throughout the 90‐days follow‐up ( P <.0001). The amelioration of pruritus was not affected by the presence of cirrhosis. Conclusions: Plasmapheresis is a promising method for reducing intractable itch in a significant proportion of PBC patients regardless of liver fibrosis. Long‐lasting improvement of symptoms requires repeated procedures.