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Plasmapheresis exerts a long‐lasting antipruritic effect in severe cholestatic itch
Author(s) -
Krawczyk Marcin,
Liebe Roman,
Wasilewicz Michał,
Wunsch Ewa,
RaszejaWyszomirska Joanna,
Milkiewicz Piotr
Publication year - 2017
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13281
Subject(s) - plasmapheresis , antipruritic , medicine , dermatology , intensive care medicine , immunology , antibody
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.