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Title: Sertraline (Zoloft) Relieves Pruritus in Cholestatic Liver Disease: Presented at AASLD

"Sertraline (Zoloft) Relieves Pruritus in Cholestatic Liver Disease: Presented at AASLD"

By Crystal Phend SAN FRANCISCO, CA -- November 17, 2005 -- The antidepressant sertraline (Zoloft) appears to relieve itching from cholestatic liver disease, according to a study presented here at the American Association for the Study of Liver Diseases (AASLD) annual meeting. "Pruritus is frequently the most debilitating symptom of cholestatic liver disease," said lead author Marlyn J. Mayo, MD, Assistant Professor of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States, during a presentation on November 13[^th.

Retrospective case reports have suggested a link between serotonin reuptake inhibitors like sertraline and pruritus.

Dr. Mayo and colleagues conducted a small prospective, randomized, placebo controlled trial to investigate whether sertraline would be an effective first-line treatment for pruritus in patients with cholestatic liver disease.

They enrolled 21 patients to undergo an open-label dose escalation of sertraline. Doses increased by 25 mg every 4 weeks.

Subjects entered the double-blind crossover phase, in which they received sertraline or placebo for 6 weeks after a washout period.

No other pruritus medications were allowed during the study. All patients had chronic pruritus from liver disease, most from primary biliary cirrhosis (57%) or hepatitis C virus (24%).

Patients kept a daily diary of pruritus symptoms using a visual analog scale and were examined by a dermatologist at baseline and at each study visit.

While the 25 mg and 50 mg doses showed little or partial improvement, the 75 mg dose of sertraline achieved the greatest improvement in symptoms, and the 100 mg dose added further benefit.

Sertraline significantly improved patient-reported itch scores by 30% compared to the worsening of scores by 24% in patients taking placebo.

Scratching lesions found on 17 of the 21 patients at baseline improved in all patients after treatment. Excoriations also showed statistically better improvement with sertraline during the double blind phase of the study.

The number of itchy areas decreased significantly during the open label phase compared to baseline, and during the double blind phase, with sertraline compared to placebo.

Although few patients in the study had clinical depression at entry, "successful treatment of depression was not required for treatment of pruritus," Dr. Mayo said.

Improvements occurred in depressed and non-depressed individuals.

Dr. Mayo reported funding by Pfizer only for travel expenses to the meeting.

[Presentation title: Effects of Sertraline on Pruritus in Cholestatic Liver Disease: A Randomized Double Blind Placebo Controlled Crossover Study. Abstract 34]

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