Sodium/Bile acid co-transporter inhibitors currently in preclinical or early clinical development for the treatment of primary biliary cholangitis.

INTRODUCTION:Pruritus is common and often undertreated in patients with primary biliary cholangitis (PBC). Existing treatments largely have an aging and low-quality evidence base, and studies included only small numbers of patients. More recent data that has added to our understanding of pruritus treatments has often come from clinical trials where itch was a secondary outcome measure in a trial designed primarily to assess disease modifying agents. This area represents an unmet clinical need in the management of PBC. AREAS COVERED:In this manuscript, we first summarize the proposed mechanisms for PBC-related pruritus and the current treatment paradigm. We then present an appraisal of the existing pre-clinical and clinical evidence for the use of ileal bile acid transporter inhibitors (IBATis) for this indication in PBC patients. EXPERT OPINION:Evidence for the efficacy of IBATis is promising but limited by the currently available volume of data. Further, larger clinical trials with longer-term data on efficacy, safety and tolerability are needed to confirm the role of using IBATis in clinical practice and their place on the itch treatment ladder. Additional focus should also be given to exploring the disease modifying potential of IBATis in PBC.