An analysis of the efficacy and safety of anti-itch agents

April 4, 2007

I thought this would be of general interest:

Am J Gastroenterol. 2007 Mar 31; [Epub ahead of print]

The Efficacy and Safety of Bile Acid Binding Agents, Opioid

Antagonists, or Rifampin in the Treatment of Cholestasis-Associated

Pruritus.

Tandon P, Rowe BH, Vandermeer B, Bain VG

Division of Gastroenterology, University of Alberta, and Capital

Health, Edmonton, Alberta, Canada.

OBJECTIVES: The objective of this review was to evaluate the efficacy

and safety of rifampin, opioid antagonists, or bile acid binding

agents in the treatment of cholestasis-related pruritus (CAP) from

available randomized controlled trial evidence. METHODS: In addition

to a comprehensive gray literature search, the Cochrane Library,

MEDLINE, EMBASE, PubMed, and Web of Science were searched. Only full-

text RCTs in participants (>75% adult) with CAP on at least one of

the three medications were included. The primary outcome was change

in pruritus score, recorded as a continuous or dichotomous outcome.

Two independent reviewers performed trial selection and quality

assessment. RESULTS: From 487 citations, 12 RCTs were included.

Rifampin (standardized mean difference [sMD]-1.62, 95% CI -3.05 to -

0.18) and opioid antagonists (SMD -0.68, 95% CI -1.19 to -0.17)

significantly reduced CAP. The two cholestyramine studies were too

heterogeneous to pool. Although cholestyramine (P= 0.35) and rifampin

(P= 0.96) were not associated with greater side effects compared with

placebo, opioid antagonists were (number needed to harm = 2.6, 95% CI

1.4-25). CONCLUSIONS: The available RCTs are small, few in number,

and use varying scales for measuring pruritus. Although both opioid

antagonists and rifampin demonstrated a reduction in pruritus, there

were insufficient data to judge the efficacy of cholestyramine.

Opioid antagonists were associated with transient side effects in a

significant proportion of patients. A longer well-designed randomized

controlled trial is needed to confirm the efficacy of bile acid

binding agents and accurately assess adverse events. PMID: 17403073.

Dave

(father of (21); PSC 07/03; UC 08/03)

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