4, 6, 7 Thus, there remains a significant unmet need for the symptomatic management of pruritus in patients with PSC. 6 Ursodeoxycholic acid, commonly used in the treatment of patients with PSC, may improve liver chemistries but does not significantly reduce pruritus. 4 Endoscopic treatment of biliary strictures may relieve pruritus in patients with a relevant stricture, 2, 5 but patients mostly rely on symptomatic treatments, such as cholestyramine, rifampicin, naltrexone, or sertraline, which are often ineffective or associated with potentially significant adverse effects. In addition to progressive liver disease, patients with PSC experience symptoms including abdominal pain and pruritus, which affects their quality of life negatively. 1 Currently, there are no medical therapies that alter the natural progression of PSC, leaving liver transplantation as the only means of treatment once end-stage liver disease is reached. 1, 2 PSC is frequently associated with inflammatory bowel disease (IBD), which may suggest an underlying immune-mediated pathology. Elevations in serum bile acids (sBAs) and in serum alkaline phosphatase (ALP) levels, as well as fluctuations in levels of other liver enzymes, are also common. 1 Common signs and symptoms of PSC include pruritus, fatigue, jaundice, and weight loss. 3 This liver damage often progresses to fibrosis, cirrhosis, and eventual liver failure. 1, 2 In PSC, damage to the bile ducts impedes bile acid (BA) flow, exposing the liver to cytotoxic BAs and causing hepatocyte injury. Primary sclerosing cholangitis (PSC) is a rare, chronic, progressive cholestatic liver disease of unknown etiology.

Maralix 2018