Antipruritic effect of bezafibrate and serum autotaxin measures in patients with primary biliary cholangitis.

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) …