Cholestatic Pruritus: A Review of Pathophysiology, Clinical Manifestations, and Therapeutic Landscape

Cholestatic pruritus is a profoundly debilitating symptom of liver diseases that impair bile flow, notably primary biliary cholangitis. This condition severely compromises health-related quality of life (HRQoL) leading to sleep disturbances, physical discomfort, and significant psychological distress. The condition involves multiple mediators like endogenous opioids, bile acids, and the cytokine interleukin-31. Conventional therapies often provide limited efficacy, prompting the advancement of the therapeutic landscape toward more targeted mechanism-based treatments. Key novel classes of therapy include ileal bile acid transport inhibitors and peroxisome proliferator-activated receptor agonists, which demonstrate statistically significant efficacy in specific patient populations, offering renewed hope for improving HRQoL.