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- Title
Plasmapheresis exerts a long-lasting antipruritic effect in severe cholestatic itch.
- Authors
Krawczyk, Marcin; Liebe, Roman; Wasilewicz, Michał; Wunsch, Ewa; Raszeja ‐ Wyszomirska, Joanna; Milkiewicz, Piotr
- 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.
- Subjects
PLASMAPHERESIS; DRUG efficacy; CHOLANGITIS; TREATMENT of cirrhosis of the liver; ITCHING; AMINOTRANSFERASES; ASPARTATE aminotransferase; ALKALINE phosphatase; THERAPEUTICS
- Publication
Liver International, 2017, Vol 37, Issue 5, p743
- ISSN
1478-3223
- Publication type
Article
- DOI
10.1111/liv.13281