ArticleLiver international : official journal of the International Association for the Study of the Liver2026
Unravelling the Itch: Cross-Sectional Analysis of Pruritus Patterns in the PicnicHealth Primary Biliary Cholangitis Registry.
Article in Liver international : official journal of the International Association for the Study of the Liver, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Unravelling the Itch: Cross-Sectional Analysis of Pruritus Patterns in the PicnicHealth Primary Biliary Cholangitis Registry.Liver international : official journal of the International Association for the Study of the Liver · 2026Article
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Authors and funding
11 authors.
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Abstract
BACKGROUND &
aimsPruritus in primary biliary cholangitis (PBC) worsens patients' health-related quality of life (HRQoL). Serum alkaline phosphatase (ALP), a biomarker of PBC activity, has an unclear relationship with pruritus severity.
methodsThis retrospective, cross-sectional analysis utilized data from participants with confirmed PBC diagnoses, from the PicnicHealth PBC registry, with ≥ 1 completed PBC-40 questionnaire (most recent was used). The primary analysis included participants with a qualifying ALP measurement. Participants were categorized by pruritus severity per PBC-40 itch domain (clinically significant [CS] pruritus [score ≥ 7], or non-CS pruritus [score = 1-6]); serum ALP (normal [ALP ≤ 1 × upper limit of normal; ULN], mildly elevated [ALP > 1-< 1.67 × ULN], or high [ALP ≥ 1.67 × ULN]; primary analysis). PRIMARY OUTCOME: proportion of participants in each pruritus severity subgroup by ALP category. Secondary outcome (all participants with PBC-40): HRQoL by pruritus severity.
resultsOverall, 232 participants completed ≥ 1 PBC-40 questionnaire; 141 had a qualifying ALP measurement. Most participants with pruritus were female (97%) and white (93%); 53% had CS pruritus. 23% (13/57), 32% (17/53) and 52% (16/31) of participants with normal, mildly elevated and high ALP, respectively, reported CS pruritus. Participants with CS pruritus had significantly higher scores across non-itch PBC-40 domains (p < 0.05) versus non-CS pruritus and greater odds of having CS PBC-40 domain scores versus no CS pruritus (p < 0.0001; odds ratio [95% CI]: Symptoms 7.08 [3.89, 12.90]; Fatigue 9.51 [4.71, 19.22]; Emotional 2.67 [1.50, 4.76]; Social 6.14 [3.47, 10.88]; Cognitive 4.03 [2.33, 6.96]).
conclusionsCS pruritus is common, present in patients irrespective of ALP levels and significantly impacts HRQoL.
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