Investigating the cholestatic pruritus of primary sclerosing cholangitis (ItCh-PSC): a study of patients participating in the consortium for autoimmune liver disease (CALiD)

Document Type

Conference Proceeding

Publication Date


Publication Title

J Hepatol


Background and aims: Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease that causes significant impairments to quality of life. Compared with other cholestatic liver diseases, pruritus has not been well studied in patients with PSC. The aim of this study was to determine the prevalence, severity and treatment patterns for pruritus among patients with PSC. Method: Patients with PSC were identified from a multicentre, retrospective cohort study of the Consortium for Autoimmune Liver Disease (CALiD). Electronic medical records were searched for keyword terms “itch” and “pruritus” to identify “pruritus” encounters. The severity of pruritus was graded for each pruritus encounter as absent, mild, moderate or severe based on descriptors in the medical record. Medications and endoscopic retrograde cholangiopancreatography (ERCP) planned to treat pruritus was recorded. Patients with more than one pruritus encounter were categorised according to the encounter with the maximum severity of pruritus. Results: A total of 724 patients were included in the study. Pruritus terms were recorded in 1178 encounters from the medical records of 372 (51.4%) patients. Patients with a pruritus encounter (N = 372, 51.4%) compared with those without (N = 352, 48.6%) had a lower frequency of small duct PSC (4% vs 8%, p = 0.02) but were comparable in terms of inflammatory bowel disease (IBD), cirrhosis, hepatic decompensation, and baseline laboratories, except for international normalised ratio (INR) 1.2 + 0.4 vs 1.2 + 0.4, p = 0.02). Among those with a pruritus encounter, the maximum pruritus severity was graded as mild in 142 (38.2%), moderate in 140 (37.6%), severe in 77 (20.7%), and pruritus was recorded as absent in 13 (3.5%) patients. IBD diagnosis, PSC type, cirrhosis and hepatic decompensation did not differ by the maximum severity of pruritus (Table). However, baseline alkaline phosphatase (ALP), aspartate transaminase (AST) and total bilirubin were greater in those with more severe itch. Anti-pruritic medication usage among patients with any degree of itch included bile acid-binding resins (36.5%), hydroxyzine (22.6%), rifampin (11.4%) and sertraline (9.7%). Two or more medications were used by 46.7% of patients with severe itch. ERCP was planned in 13 (2.5%), 34 (8.4%), 27 (17.3%) encounters with mild, moderate and severe pruritus, respectively. Conclusion: Pruritus in patients with PSC is notwell documented but is frequent and often severe. Patients who experience severe pruritus have more severe liver disease and frequently require multiple antipruritic medications and ERCP. These results establish the clinical significance of pruritus in PSC and support the need for prospective studies to accurately ascertain itch prevalence and the unmet need for therapies to treat pruritus among patients with PSC. [Figure presented]

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Not assigned.



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