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PBC Pruritus and Fatigue Symptoms

CE / CME

Management of PBC Pruritus and Fatigue Symptoms

Pharmacists: 0.75 contact hour (0.075 CEUs)

Physicians: maximum of 0.75 AMA PRA Category 1 Credit

Nurse Practitioners/Nurses: 0.75 Nursing contact hour

Released: March 18, 2026

Expiration: March 17, 2027

Activity

Progress
1 2 3
Course Completed

References

  1. Fiorucci S, Urbani G, Di Giorgio C, et al. Current landscape and evolving therapies for primary biliary cholangitis. Cells. 2024;13:1580. 
  2. Lindor KD, Bowlus CL, Boyer J, et al. Primary biliary cholangitis: 2018 practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2019;69:394-419. 
  3. Mayo MJ, Carey E, Smith HT, et al. Impact of pruritus on quality of life and current treatment patterns in patients with primary biliary cholangitis. Dig Dis Sci. 2023;68:995-1005.
  4. Mitchell C, Eddy A, Neuberger J, et al. Patient experience of primary biliary cholangitis (PBC) symptom evaluation and management in clinical appointments and pathways compared to The British Society of Gastroenterology (BSG)/UK-PBC PBC treatment and management guidelines: Results from PBC Foundation mobile app patient survey. Gut. 2022;71:A39-A41.
  5. Carey EJ, Levy C, Mayo M, et al. Patient-Reported Indicators of Health and Symptoms in US Patients with Primary Biliary Cholangitis (PBC). Presented at: 2018 American Association for the Study of Liver Diseases annual meeting; November 9-13, 2018. Abstract 1948.
  6. Mitchell-Thain R, Levy C, Kowdley K, et al. Management of cholestatic pruritus in primary biliary cholangitis: ileal bile acid transporter inhibition and holistic care. EMJ Hepatol. 2023;11:24-33.
  7. Düll MM, Kremer AE. Evaluation and management of pruritus in primary biliary cholangitis. Clin Liver Dis. 2022;26:727-745. 
  8. Kwatra SG, Rodriguez D, Dias-Barbosa C, et al. Validation of the peak pruritus numerical rating scale as a patient-reported outcome measure in prurigo nodularis. Dermatol Ther (Heidelb). 2023;13:2403-2416. 
  9. Fujino H, Tanaka M, Imamura M, et al. Pruritus in patients with chronic liver disease and serum autotaxin levels in patients with primary biliary cholangitis. BMC Gastroenterol. 2019;19:169.
  10. Nietsche TR, Dotta G, Barcaui CB, et al. Cholestatic pruritus: a knowledge update. An Bras Dermatol. 2022;97:332-337. 
  11. Langedijk JAGM, Beuers UH, Oude Elferink RPJ. Cholestasis-associated pruritus and its pruritogens. Front Med (Lausanne). 2021;8:639674.
  12. Newton JL, Bhala N, Burt J, Jones DE. Characterisation of the associations and impact of symptoms in primary biliary cirrhosis using a disease specific quality of life measure. J Hepatol. 2006;44:776-783.
  13. Hirschfield G, Bowlus C, Jones D, et al. Insufficient control of cholestatic pruritus in primary biliary cholangitis (PBC) with current therapies: baseline data from the ongoing Phase 3 GLISTEN (Global Linerixibat Itch STudy of Efficacy and safety iN PBC) trial. Presented at: 2024 American Association for the Study of Liver Diseases annual meeting; November 15-19, 2024. Abstract 4290.
  14. Pate J, Gutierrez JA, Frenette CT, et al. Practical strategies for pruritus management in the obeticholic acid-treated patient with PBC: proceedings from the 2018 expert panel. BMJ Open Gastroenterol. 2019;6:e000256.
  15. Vander Does A, Levy C, Yosipovitch G. Cholestatic itch: our current understanding of pathophysiology and treatments. Am J Clin Dermatol. 2022;23:647-659. 
  16. Saliba F. The Molecular Adsorbent Recirculating System (MARS) in the intensive care unit: a rescue therapy for patients with hepatic failure. Crit Care. 2006;10:118.
  17. Kowdley KV, Bowlus CL, Levy C, et al. Efficacy and safety of elafibranor in primary biliary cholangitis. N Engl J Med. 2024;390:795-805. 
  18. Levy C, Akarca U, Alvares-da-Silva MR, et al. Long-term treatment with elafibranor leads to biochemical and symptomatic improvements for at least 3 years in patients with primary biliary cholangitis. Presented at: 2025 American Association for the Study of Liver Diseases; November 7-11, 2025. Abstract 5016.
  19. Hirschfield GM, Bowlus CL, Mayo MJ, et al. A phase 3 trial of seladelpar in primary biliary cholangitis. N Engl J Med. 2024;390:783-794. 
  20. Pratt D, Lawitz EJ, Bowlus CL et al. Seladelpar is associated with a sustained reduction in cholestatic markers and a consistent safety profile in patients with PBC treated up to 48 months in the ongoing, open-label ASSURE study. Presented at: 2025 American Association for the Study of Liver Diseases; November 7-11, 2025. Abstract 0213.
  21. Heneghan M, Shiffman M, Weinstein D, et al. Volixibat for the treatment of cholestatic pruritus in primary biliary cholangitis: an adaptive, randomized, placebo-controlled phase 2b trial (VANTAGE): 28-week interim results. Presented at: 2025 European Association for the Study of the Liver Congress; May 7-10, 2025. Abstract OS-059.
  22. Hirschfield GM, Kremer AE, Levy C. Antipruritic effects of the ileal bile acid transporter inhibitor linerixibat. Lancet Gastroenterol Hepatol. 2026;11:182. 
  23. Rishe E, Azarm A, Bergasa NV. Itch in primary biliary cirrhosis: a patients' perspective. Acta Derm Venereol. 2008;88:34-37.
  24. Martin ML, Stassek L, Blum SI, et al. Development and adaptation of patient-reported outcome measures for patients who experience itch associated with primary biliary cholangitis. J Patient Rep Outcomes. 2019;3:2. 
  25. Montagnese S, Nsemi LM, Cazzagon N, et al. Sleep-wake profiles in patients with primary biliary cirrhosis. Liver Int. 2013;33:203-209.
  26. Shamshtein D, Liwinski T. Pathogenesis and management of fatigue in primary biliary cholangitis. Fatigue: Biomedicine, Health & Behavior. 2022;10:1–25.
  27. Jopson L, Dyson JK, Jones DE. Understanding and treating fatigue in primary biliary cirrhosis and primary sclerosing cholangitis. Clin Liver Dis. 2016;20:131-242. 
  28. Levy C, Kendrick S, Bowlus CL, et al. GLIMMER: a randomized phase 2b dose-ranging trial of linerixibat in primary biliary cholangitis patients with pruritus. Clin Gastroenterol Hepatol. 2023;21:1902-1912.e13. 
  29. Khanna A, Hegade VS, Jones DE. Management of fatigue in primary biliary cholangitis. Curr Hepatology Rep. 2019;18:127-133.
  30. Freer A, Williams FR, Durman S, et al. A home-based exercise programme attenuates fatigue in primary biliary cholangitis: results from the EXCITED clinical trial. JHEP Rep. 2024;6:101210. 
  31. Watt M, Hyde A, Johnson E, et al. An online mind-body program improves mental health and quality of life in primary biliary cholangitis: a randomized controlled trial. Hepatol Commun. 2023;7:e0316.
  32. Untas A, Goffette C, Flahault C, et al. PBC-HOPE: a randomized controlled trial of hypnosis and psychoeducation in women with primary biliary cholangitis and fatigue. Am J Gastroenterol. 2025;[Epub ahead of print].
  33. Kremer AE, Mayo MJ, Hirschfield G, et al. Seladelpar improved measures of pruritus, sleep, and fatigue and decreased serum bile acids in patients with primary biliary cholangitis. Liver Int. 2022;42:112-123.
  34. Silveira MG, Gossard AA, Stahler AC, et al. A randomized, placebo-controlled clinical trial of efficacy and safety: modafinil in the treatment of fatigue in patients with primary biliary cirrhosis. Am J Ther. 2017;24:e167-e176.
  35. Khanna A, Jopson L, Howel D, et al. Rituximab is ineffective for treatment of fatigue in primary biliary cholangitis: a phase 2 randomized controlled trial. Hepatology. 2019;70:1646-1657. 
  36. Talwalkar JA, Donlinger JJ, Gossard AA, et al. Fluoxetine for the treatment of fatigue in primary biliary cirrhosis: a randomized, double-blind controlled trial. Dig Dis Sci. 2006;51:1985-1991. 
  37. Prince MI, Mitchison HC, Ashley D, et al. Oral antioxidant supplementation for fatigue associated with primary biliary cirrhosis: results of a multicentre, randomized, placebo-controlled, cross-over trial. Aliment Pharmacol Ther. 2003;17:137-143. 
  38. Harms MH, van Buuren HR, Corpechot C, et al. Ursodeoxycholic acid therapy and liver transplant-free survival in patients with primary biliary cholangitis. J Hepatol. 2019;71:357-365. 
  39. Hirschfield GM, Mason A, Luketic V, et al. Efficacy of obeticholic acid in patients with primary biliary cirrhosis and inadequate response to ursodeoxycholic acid. Gastroenterology. 2015;148:751-61.e8.