Extracorporeal devices for treatment of refractory pruritus in cholestatic liver disease

Excerpt

An invitation to write an editorial around the paper entitled “Charcoal hemoperfusion in the treatment of medically refractory pruritus in cholestatic liver disease” was just too much for me to resist. Since the 1970s and our early work on hemoperfusion for temporary liver support in fulminant hepatic failure, I have had a passionate belief in the value of charcoal and other adsorbents for removal of protein-bound toxic substances [1]. Intractable pruritus defines failure of control by the well-tried sequential regime of bile acid sequestrant (cholestyramine or colesevelam), enzyme-inducing agent (rifampicin), opioid antagonist (naltrexone), and selective serotonin inhibitor (sertraline). It affects a relatively small group of patients with primary biliary cholangitis (PBC), 3–5% only. Nevertheless, for these patients, pruritus can be disabling with poor quality of life, sleep deprivation, and even suicidal ideation. The cause of the severe pruritus has long been a puzzle, as there is no correlation with the severity of the underlying disease. Liver structure and function are often well preserved in these patients, making transplantation—which is the last resort in treatment—difficult to justify. …