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Letter
Antipruritic effect of bezafibrate and serum autotaxin measures in patients with primary biliary cholangitis
  1. Andreas E Kremer1,
  2. Aline Le Cleac’h2,
  3. Sara Lemoinne2,3,
  4. Katharina Wolf1,
  5. Luc De Chaisemartin4,5,
  6. Sylvie Chollet-Martin4,5,
  7. Lydie Humbert6,
  8. Dominique Rainteau6,7,
  9. Raoul Poupon2,
  10. Alexandra Rousseau8,
  11. Olivier Chazouillères2,3,
  12. Christophe Corpechot2,3
  1. 1 Department of Medicine 1 and Translational Research Center, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
  2. 2 Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, Saint-Antoine Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
  3. 3 Inserm UMR_S938, Sorbonne University, Paris, France
  4. 4 Immunology Laboratory, Bichat Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
  5. 5 Inserm UMR_S996, Paris-Sud University, Paris, France
  6. 6 INSERM 1157/UMR 7203, Sorbonne University, Paris, France
  7. 7 Biochemistry Laboratory, Saint-Antoine Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
  8. 8 Clinical Research Platform of East of Paris, Saint-Antoine Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
  1. Correspondence to Dr Christophe Corpechot, Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, Saint-Antoine Hospital, Assistance Publique - Hôpitaux de Paris, Paris 75012, France; christophe.corpechot{at}aphp.fr

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It was with great interest that we read the recent guidelines from the British Society of Gastroenterology on the treatment and management of primary biliary cholangitis (PBC).1 The authors propose a pragmatic drug approach to treat cholestatic pruritus with cholestyramine as first-line and rifampicin as second-line use, followed by naltrexone, sertraline or gabapentin as third-line options, although with concerns regarding tolerability and adverse events.

Pruritus is a characteristic, potentially agonising symptom of PBC that remains poorly cared.2 New drug options are definitively needed to relieve patients of this symptom. Bezafibrate, a pan-agonist of peroxisome proliferator-activated receptors, has been suggested to reduce itch intensity in patients with PBC.3 This beneficial effect has recently been confirmed in a placebo-controlled phase III trial Bezafibrate in Combination with Ursodeoxycholic Acid in PBC (BEZURSO).4 The mechanisms by which bezafibrate improves pruritus in PBC remain unknown. As the lysophospholipase autotaxin (ATX) and its product, lysophosphatidic acid, have been identified as potential key players in the pathogenesis of cholestatic pruritus,5 the present post-hoc analysis of the BEZURSO trial aims to investigate the role of ATX in the antipruritic effect of bezafibrate in patients with PBC.

All patients met the following criteria at inclusion: (1) PBC diagnosis and (2) …

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