Dean Richard, Yazdanfar Maryam, Zepeda Joseph, Levy Cynthia, Lammert Craig, Pratt Daniel, Gordon Stuart C, Forman Lisa, Assis David N, McGirr Ashleigh, McLaughlin Megan, Mukherjee Sumanta, Gungabissoon Usha, Bowlus Christopher L
Division of Gastroenterology and Hepatology, University of California Davis, Sacramento, California, USA.
Schiff Center of Liver Disease and Division of Gastroenterology and Hepatology, University of Miami, Miami, Florida, USA.
Hepatol Commun. 2025 May 6;9(5). doi: 10.1097/HC9.0000000000000703. eCollection 2025 May 1.
Cholestasis from primary sclerosing cholangitis (PSC) frequently causes pruritus. However, the prevalence of pruritus and its management have not been well studied. Investigating the Cholestatic Pruritus of Primary Sclerosing Cholangitis (ItCh-PSC) includes a retrospective medical record review to determine the prevalence, severity, and treatment patterns of pruritus.
Data was collected at 5 academic medical centers in the United States. Medical records were searched for the terms "itch" and "pruritus" and data abstracted related to itch severity, number of encounters, and treatment.
Among 724 patients with PSC, 359 (50%) of patients had a documented history of pruritus, including 40%, 39%, and 21% with mild, moderate, or severe itch. Itch was less common in those with small ducts compared to large duct PSC (p=0.02) and more frequent in those of Hispanic versus non-Hispanic ethnicity (p=0.001). Compared to patients with mild itch, patients with moderate or severe itch were younger, and had more elevated liver biochemistries, more encounters with itch, and more frequently prescribed 2 or more anti-pruritic medications. Bile acid-binding resins were prescribed in 36%, hydroxyzine in 23%, rifampin in 11%, and fenofibrate in 4% of patients with any itch. The prevalence and severity of pruritus were not affected by cirrhosis, hepatic decompensation, or inflammatory bowel disease.
Itch is common in patients with PSC and is often associated with multiple prescriptions of antipruritic agents. Effective treatments for pruritus in patients with PSC remain an unmet need.
原发性硬化性胆管炎（PSC）所致胆汁淤积常引起瘙痒。然而，瘙痒的患病率及其管理尚未得到充分研究。原发性硬化性胆管炎胆汁淤积性瘙痒研究（ItCh-PSC）包括一项回顾性病历审查，以确定瘙痒的患病率、严重程度和治疗模式。
在美国5家学术医疗中心收集数据。在病历中搜索“瘙痒”和“痒”等术语，并提取与瘙痒严重程度、就诊次数和治疗相关的数据。
在724例PSC患者中，359例（50%）有瘙痒病史记录，其中轻度、中度或重度瘙痒患者分别占40%、39%和21%。与大胆管PSC患者相比，小胆管患者瘙痒较少见（p=0.02），西班牙裔患者比非西班牙裔患者更常出现瘙痒（p=0.001）。与轻度瘙痒患者相比，中度或重度瘙痒患者更年轻，肝脏生化指标升高更明显，瘙痒就诊次数更多，更常开具2种或更多抗瘙痒药物。有任何瘙痒症状的患者中，36%开具了胆汁酸结合树脂，23%开具了羟嗪，11%开具了利福平，4%开具了非诺贝特。瘙痒的患病率和严重程度不受肝硬化、肝失代偿或炎症性肠病的影响。
瘙痒在PSC患者中很常见，且常与多种抗瘙痒药物处方相关。PSC患者瘙痒的有效治疗方法仍未满足需求。
