Ileal Bile Acid Transport Inhibitors for Cholestatic Pruritus: A Primer

Abstract Purpose of Review Cholestatic pruritus is a debilitating symptom in cholestatic liver diseases, often resistant to conventional therapies. This review examines the emerging role of ileal bile acid transporter (IBAT) inhibitors (IBATi) in managing cholestatic pruritus, focusing on their mechanism of action, clinical efficacy, and practical considerations in clinical use. Recent Findings IBATi reduce pruritus severity by disrupting bile acid reabsorption and modifying enterohepatic circulation. Clinical trials and real-world evidence suggest their efficacy in both pediatric and adult chronic cholestatic diseases, with a favorable safety profile. Summary IBATi represent a promising targeted therapy for cholestatic pruritus, offering a more effective and better-tolerated option than traditional treatments. Further studies are needed to refine patient selection, long-term safety, and potential disease-modifying effects.