Cholestatic Pruritus: Current Management Approach and Emerging Therapies – Mini Review

Cholestatic Pruritus is a phenomenon that occurs in disease processes that impair bile flow. This condition poses significant challenges to quality of life and is often underdiagnosed and undertreated. While the direct cause of cholestatic pruritus remains unclear, it likely involves a complex interplay between multiple biochemical pathways. Due to recent advances in diagnostic tools, more biochemical pathways of cholestatic pruritis have been discovered. As a result, exciting new therapies such as the Ileal Bile Acid Transporter (IBAT) inhibitors and peroxisome proliferator-activated receptor (PPAR) agonists are emerging as effective therapies. In this article, we provide a brief biochemical summary of the various pathways as candidate causes of cholestatic pruritus and examine the evidence behind each of the current available therapeutic options. Additionally, we will discuss emerging therapies and examine the evidence behind their use. Finally, we will provide our recommended stepwise approach to treating a patient with cholestatic pruritus in both the inpatient and outpatient settings.