Systematic review shows high fatigue and pruritus prevalence in primary biliary cholangitis patients

This systematic review and meta-analysis assessed the prevalence and severity of symptom burden in patients with primary biliary cholangitis. The analysis included a total sample size of 13178 patients. The specific setting of the included studies was not reported in the source data. The review aimed to quantify the burden of common symptoms such as fatigue and pruritus, which are known to significantly impact quality of life in this chronic liver disease.

The primary outcome measured was the prevalence of fatigue and pruritus. Fatigue was reported in 51% of the total patient population. Pruritus was reported in 33% of patients. The review also examined the prevalence of severe forms of these symptoms. Severe fatigue was present in 23% of patients. Severe pruritus was present in 10% of patients. These figures underscore the widespread nature of these debilitating symptoms across the disease spectrum.

Secondary outcomes included the use of anti-pruritic treatment and symptom severity stratified by demographic and clinical factors. Among patients with pruritus, 36% received anti-pruritic treatment. Fatigue scores were significantly higher in female patients compared with males. The direction of this difference was higher in females. This sex-based disparity suggests a potential need for tailored management approaches for women with primary biliary cholangitis.

Geographic and clinical characteristics influenced symptom severity. Severe fatigue prevalence was 26% in North America and Europe versus 8% in Asia. The p-value for this difference was 0.0005. Severe fatigue prevalence was 28% in studies with a higher proportion of patients with cirrhosis versus 8% in others. The p-value for this association was also 0.0005. Furthermore, fatigue prevalence was significantly higher in more recent studies, those with smaller sample sizes, and studies published as abstracts.

Safety and tolerability data were not reported in the source material. Adverse events, serious adverse events, discontinuations, and general tolerability were not reported. Consequently, no specific adverse-event rates or safety profiles could be derived from this review. The limitations of the included studies were not reported. This lack of detail prevents a full assessment of the risks associated with the conditions or treatments discussed.

The practice relevance of these findings is substantial. The proportion and quality of appropriate symptom management in primary biliary cholangitis are suboptimal. There remains an unmet need for standardized assessment, consistent reporting, and improved management strategies for primary biliary cholangitis-related symptoms. These gaps in care highlight the necessity for clinicians to actively screen for and address these high-prevalence symptoms.

Several questions remain unanswered due to the nature of the data. The specific interventions used to manage these symptoms were not reported. The comparators for treatment efficacy were not reported. The detailed study designs and protocols were not reported. Without this information, direct clinical application of specific pharmacological or non-pharmacological interventions is limited. Clinicians must rely on general symptom management principles while awaiting more granular data.