Pate Jennifer, Gutierrez Juilo A, Frenette Catherine T, Goel Aparna, Kumar Sonal, Manch Richard A, Mena Edward A, Pockros Paul J, Satapathy Sanjaya K, Yimam Kidist K, Gish Robert G
Baylor St Luke's Medical Center, Houston, Texas, USA.
Transplant and Hepatopancreatobiliary Institute, Verity Medical Foundation, San Jose, California, USA.
BMJ Open Gastroenterol. 2019 Feb 1;6(1):e000256. doi: 10.1136/bmjgast-2018-000256. eCollection 2019.
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.
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.
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.
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.
本文为接受奥贝胆酸（OCA）治疗原发性胆汁性胆管炎（PBC）的患者瘙痒症状管理提供专家指导。PBC是一种影响肝内胆管的慢性自身免疫性胆汁淤积性肝病。若未得到充分治疗，PBC可导致胆汁淤积和终末期肝病，可能需要进行移植。因此，及时治疗对患者健康至关重要。瘙痒是PBC患者的常见症状。此外，使用OCA治疗PBC可能会导致部分患者瘙痒严重程度增加，加重患者不适，降低患者生活质量（QoL），并可能影响患者对OCA治疗的依从性。
2018年5月，一组来自胃肠病学、肝病学和精神病学领域的医师专家会面，讨论接受OCA治疗的PBC患者瘙痒的管理。认识到优化PBC治疗的重要性，这些专家根据他们的临床实践经验，制定了针对接受OCA治疗的PBC患者瘙痒症状管理的建议。
这些建议包括一份全面的管理策略清单（包括非处方、处方和替代疗法）、关于调整OCA剂量以尽量减轻瘙痒严重程度的指导，以及一种算法，该算法概述了对接受OCA治疗的患者进行随访的实用方法，以更好地评估和管理瘙痒症状。
与OCA治疗相关的瘙痒是剂量依赖性的，通常是可控的，通过适当的教育和工具，大多数瘙痒病例可以得到有效管理，以尽量减少治疗中断。
