Hepatology
Signal score, how each part rates
ActionabilityPrevalenceStakesEvidence strengthNovelty
See the full rubric →Unravelling the Itch: Cross-Sectional Analysis of Pruritus Patterns in the PicnicHealth Primary Biliary Cholangitis Registry.
Clinical takeawayAssess pruritus and its impact on quality of life in all PBC patients, regardless of ALP levels, and consider targeted itch management for those with clinically significant pruritus (PBC-40 itch domain score ≥7).
What it found52% of patients with high ALP (≥1.67 × ULN) reported clinically significant pruritus (PBC-40 itch domain score ≥7), versus 23% with normal ALP (≤1 × ULN).
ContextConfirms pruritus is common in PBC and impacts HRQoL, independent of ALP levels, challenging the assumption that ALP correlates with itch severity.
Emergingsuggested applicable standard· American Association for the Study of Liver Diseases, 'Primary Biliary Cholangitis: 2021 Practice Guidance', 2021
American Association for the Study of Liver Diseases, 'Primary Biliary Cholangitis: 2021 Practice Guidance', 2021 · reviewed 2026-07-21 ↗Treat with first-line ursodeoxycholic acid (UDCA) 13-15 mg/kg/d divided, and assess biochemical response at 12 months using Paris-II plus continuous risk scores (Globe, UK-PBC). Escalate to a second-line agent (obeticholic acid [contraindicated in cirrhosis with portal hypertension or prior decompensation], seladelpar, elafibranor, or a fibrate) when response is inadequate, guided by a Child-Pugh/portal-hypertension hard gate, and manage pruritus with a stepwise ladder (cholestyramine → rifampin → sertraline → naltrexone). Refer for transplant evaluation for decompensation, refractory pruritus, or rising bilirubin.
Levy C … Halliday A · Liver International : Official Journal of the International Association for the Study of the Liver · IF 6.7 · PubMed ↗