Symptom burden and treatment patterns in primary biliary cholangitis: A systematic review and meta-analysis

Patients with primary biliary cholangitis (PBC) often suffer from debilitating symptoms, yet the overall symptom burden has not been systematically quantified. This study aims to systematically review the prevalence and severity of the symptom burden in PBC patients.

We conducted a systematic search of 3 electronic databases to include studies that reported the prevalence and severity of PBC symptoms. Subgroup analyses were performed based on study type, publication year, risk of bias, study location, sex, and latitude.

A total of 25 studies involving 13,178 patients were included. Fatigue was the most common symptom, affecting 51% of patients, followed by pruritus at 33%. Severe fatigue and severe pruritus were reported in 23% and 10% of patients, respectively. The prevalence of fatigue was significantly higher in more recent studies, those with smaller sample sizes, and studies published as abstracts. Fatigue score was significantly higher in female patients compared with males. Severe fatigue was more prevalent in studies conducted in North America/Europe than those from Asia (26% vs. 8%, p=0.0005), and in studies with a higher proportion of patients with cirrhosis (28% vs. 8%, p=0.0005). Despite the high burden, only 36% of PBC patients with pruritus received anti-pruritic treatment, with antihistamines being the most frequently prescribed medication.

Over half of PBC patients experience significant symptom burden, with substantial ethnic disparities identified. The proportion and quality of appropriate symptom management in PBC are suboptimal. There remains an unmet need for standardized assessment, consistent reporting, and improved management strategies for PBC-related symptoms in future research.