Categories
Change Password!
Reset Password!
PPAR agonists consistently improve itch-specific outcomes in primary biliary cholangitis, strengthening their therapeutic potential for patients with persistent pruritus.
Persistent pruritus remains a hallmark of symptomatic primary biliary cholangitis (PBC), exerting a disproportionate impact on patients' sleep, psychological well-being, and daily functioning despite established therapy. As clinical attention increasingly turns toward peroxisome proliferator-activated receptor (PPAR) agonists for symptom optimization, this systematic review and meta-analysis evaluated their efficacy in reducing pruritus and improving health-related quality of life (HRQoL).
Investigators reviewed randomized controlled trials (RCTs) issued through December 2025 that evaluated bezafibrate, elafibranor, or seladelpar in PBC. Five eligible trials involving 660 patients (390 receiving PPAR agonists and 270 receiving placebo) were included. Pruritus analyses were limited to patients with moderate-to-severe baseline symptoms (numerical rating scale [NRS] ≥4) whenever such data were available.
Primary outcomes included changes in NRS and the PBC-40 total score, with pooled effects estimated using random-effects models. Compared with placebo, PPAR agonists significantly reduced pruritus intensity at 3 months, 6 months, and 12 months (Table 1).
In analyses of individual agents, bezafibrate and seladelpar attained statistically significant improvements at two or more time points. PPAR agonists also improved PBC-40 itch-domain and 5D-Itch scores, indicating consistent benefits in itch-specific patient-reported outcomes. However, despite improvements in pruritus, the meta-analysis did not demonstrate a significant benefit in overall HRQoL, as measured by the PBC-40 total score, and the certainty of evidence for this outcome remained lower.
To sum up, PPAR agonists—particularly bezafibrate and seladelpar—successfully reduce pruritus in patients with moderate-to-severe PBC, while evidence for broader quality-of-life improvements remains inconclusive. The authors emphasized the need for future PBC trials to incorporate validated, symptom-focused endpoints to better capture clinically meaningful treatment benefits.
Alimentary Pharmacology & Therapeutics
Meta-Analysis: PPAR Agonists for Pruritus and Quality of Life in Primary Biliary Cholangitis
Adrielly Martins et al.
Comments (0)