Comparison of Sertraline with Rifampin in the treatment of Cholestatic Pruritus: A Randomized Clinical Trial

Author(s): Sara Ataei, Leila Kord, Amir Larki, Fatemeh Yasrebifar, Maryam Mehrpooya, Maryam Seyedtabib, Maryam Hasanzarrini*.

Journal Name: Reviews on Recent Clinical Trials

Volume 14 , Issue 3 , 2019

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Graphical Abstract:


Background: Pruritus is one of the most common and disabling symptoms of liver disease such as Primary Sclerosing Cholangitis and Primary Biliary Cholangitis. Cholestyramine, rifampin, opioid antagonists, antihistaminic agents and SSRIs are used for the management of pruritus. Due to rifampin drug interactions as well as its serious side effects such as hepatotoxicity, clinicians are endeavoruing to find a safer and a more effective substitution.

Objective: The purpose of this study was to compare the efficacy and safety of sertraline with rifampin in the management of cholestatic pruritus.

Methods: In a single-blinded randomized clinical trial a total of 36 patients of PSC and PBC were divided into two equal groups, one group received 100 mg/day sertraline and the other group received rifampin 300 mg/day for 4 weeks. Visual analog scale was used to record pruritus severity at baseline and 4 weeks after drug intervention, also, ALT, AST, ALP and total bilirubin of all patients were measured at three different time points.

Results: Over the follow-up period, pruritus had relieved in both groups, but there was no significant differences between sertraline and rifampin in pruritus management (pvalue=0.740), also there was no significant difference between the two intervention strategies (A versus B) in total bilirubin level (pvalue=0.106). Moreover, the ALT, AST and ALP levels were found to be significantly different between the two groups (Pvalue˂0.01).

Conclusion: There is no difference between sertraline and rifampin in pruritus improvement, but sertraline has less adverse effects on hepatobiliary enzyme levels, so it seems to be safer than rifampin.

Keywords: Cholestasis, hepatotoxicity, pruritus, rifampin, randomized clinical trial, sertraline.

Kremer AE, Bolier R, van Dijk R, Elferink RPO, Beuers U. Advances in pathogenesis and management of pruritus in cholestasis. Digestiv Dis 2014; 32(5): 637-45.
Huesmann M, Huesmann T, Osada N, Phan NQ, Kremer AE, Ständer S. Cholestatic pruritus: A retrospective analysis on clinical characteristics and treatment response. J Dtsch Dermatol Ges 2013; 11(2): 158-68.
Mela M, Mancuso A, Burroughs A. Pruritus in cholestatic and other liver diseases. Aliment Pharmacol Ther 2003; 17(7): 857-70.
Metze D, Luger T. Nervous system in the skin The biology of the skin. New York: Parthenon 2001; pp. 153-76.
Bassari R, Koea JB. Jaundice associated pruritis: A review of pathophysiology and treatment. World J Gastroenterol 2015; 21(5): 1404.
Beuers U, Kremer AE, Bolier R, Elferink RPO. Pruritus in cholestasis: facts and fiction. Hepatology 2014; 60(1): 399-407.
Browning J, Combes B, Mayo MJ. Long-term efficacy of sertraline as a treatment for cholestatic pruritus in patients with primary biliary cirrhosis. Am J Gastroenterol 2003; 98(12): 2736.
Imam MH, Gossard AA, Sinakos E, Lindor KD. Pathogenesis and management of pruritus in cholestatic liver disease. J Gastroenterol Hepatol 2012; 27(7): 1150-8.
Reich A, Heisig M, Phan NQ, et al. Visual analogue scale: Evaluation of the instrument for the assessment of pruritus. Acta Dermato-venereol 2012; 92(5): 497-501.
Acocella G. Clinical pharmacokinetics of rifampicin. Clin Pharmacokinet 1978; 3(2): 108-27.
De Vane CL, Liston HL, Markowitz JS. Clinical pharmacokinetics of sertraline. Clin Pharmacokinet 2002; 41(15): 1247-66.
Amidi N, Moradkhani S, Sedaghat M, et al. Effect of green tea on inflammation and oxidative stress in cisplatin-induced experimental liver function. J Herb Med Pharmacol 2015; 2015: 5.
Jessurun J. Histopathologic approach to cholestatic diseases of the liver. AJSP Rev Rep 2018; 23(5): 199-213.
Weber MB, Camozzato FO. Pruritus Dermatology in public health environments. Berlin: Springer 2018; pp. 1279-98.
Patel T, Yosipovitch G. Therapy of pruritus. Expert Opin Pharmacother 2010; 11(10): 1673-82.
Connolly CS, Kantor GR, Menduke H. Hepatobiliary pruritus: What are effective treatments? J Am Acad Dermatol 1995; 33(5): 801-5.
Mayo MJ, Handem I, Saldana S, et al. Sertraline as a first‐line treatment for cholestatic pruritus. Hepatology 2007; 45(3): 666-74.
Thébaut A, Habes D, Gottrand F, et al. Sertraline as an additional treatment for cholestatic pruritus in children. J Pediatr Gastroenterol Nutr 2017; 64(3): 431-5.
Bachs L, Elena M, Parés A, Piera C, Rodés J. Comparison of rifampicin with phenobarbitone for treatment of pruritus in biliary cirrhosis. Lancet 1989; 333(8638): 574-6.
Tandon P, Rowe BH, Vandermeer B, Bain VG. The efficacy and safety of bile Acid binding agents, opioid antagonists, or rifampin in the treatment of cholestasis-associated pruritus. Am J Gastroenterol 2007; 102(7): 1528.
Prince M, Burt A, Jones D. Hepatitis and liver dysfunction with rifampicin therapy for pruritus in primary biliary cirrhosis. Gut 2002; 50(3): 436-9.
Tabak F, Gunduz F, Tahan V, Tabak O, Ozaras R. Sertraline hepatotoxicity: Report of a case and review of the literature. Dig Dis Sci 2009; 54(7): 1589-91.

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Article Details

Year: 2019
Page: [217 - 223]
Pages: 7
DOI: 10.2174/1574887114666190328130720
Price: $65

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