The PBC Pruritus Management Protocol: consensus of an Expert group.

Background Primary biliary cholangitis (PBC) is a rare chronic cholestatic autoimmune liver disease that can lead to the development of fibrosis, cirrhosis and hepatic decompensation. Pruritus is one of the most common symptoms of PBC, affecting more than 50 % of patients with a significant impact on quality of life. The EASL Clinical Practice Guidelines recommend symptoms evaluation in all PBC patients and a stepwise approach to pharmacological treatment of pruritus. However, management of PBC symptoms, particularly pruritus, can be challenging for clinicians.

Methods A group of European PBC specialists convened (with transparent financial support from industry) with the aim to develop a stepwise protocol for managing pruritus in PBC patients and to provide a standardized tool to support clinicians in daily-practice. It was agreed that the protocol should give clinical advice on assessment of presence and pruritus severity, treatment approach and appropriate follow up.

Results The PBC experts reached a consensus and, based on the EASL clinical guidelines and on their clinical experience, developed a stepwise protocol for managing pruritus in PBC patients: the final version is made of a four part structure dedicated to characterization of pruritus, management advices, a step-by-step approach pharmacological treatment, follow up timing and strategies ([Fig. 1]). Pruritus management advices, to be shared with patients, included over-the-counter pharmacological options (e.g. topical emollients), behavioural advices (environmental condition, clothing, hygienic suggestions) and join patient support groups. If management advices are not sufficient, expert group supported the EASL Guidelines pharmacological approach and listed relevant precautions to ensure its optimal management.

Conclusions The protocol provides an opportunity for more uniform practice and the correct clinical characterization and treatment of pruritus in patients with PBC. A standardized and optimized approach to pruritus can improve PBC management reducing the negative impact of this symptom on patient’s quality of life.

AbbFigure 1 PBC Pruritus Management Algorithm.

Publication History

Article published online:
10 June 2021