Dupilumab treatment for cholestatic pruritus.
Dupilumab treatment for cholestatic pruritus.
复制标题
Dupilumab 治疗胆汁淤积性瘙痒。
DOI：
10.1111/dth.15296
复制
发表时间：
2022
影响因子：
3.6
通讯作者：
Hung,Adelina
中科院分区：
文献类型：
--
作者：
Chovatiya,Raj;Brieva,Joaquin;Hung,Adelina
胆汁淤积性瘙痒(CP)是一种高负担的疾病，见于多种肝胆疾病(HBD)，由于病因不明难以治疗，甚至在没有明显肝功能衰竭的情况下也可能需要进行肝移植。我们报告了一例成功地用杜匹鲁单抗治疗CP的病例，这是一种针对IL-4受体α亚单位的全人型单抗。当常规血检发现肝胆汁淤积时，一名37岁的男子处于正常健康状态。MRI/MRCP成像显示双侧肝管的胆管改变，肝活检显示显著的门静脉淋巴浆细胞浸润性、交界性肝炎和II期纤维化-与原发性硬化性胆管炎(PSC)/自身免疫性肝炎(AIH)重叠一致。患者服用硫唑嘌呤后病情稳定，直到39岁出现胆汁淤积加重(总胆红素7.8 mg/dL)并伴有严重瘙痒。ERCP显示胆总管明显狭窄，放置了支架。胆汁淤积(总胆红素2.2 mg/dL)和瘙痒在接下来的几个月里得到了改善，在支架取出后，他的瘙痒最初得到了很好的控制，每天服用
Cholestatic pruritus (CP) is highly burdensome, observed in a multitude of hepatobiliary diseases (HBDs), difficult to treat given unclear etiopathogenesis, and may necessitate liver transplantation even in the absence of overt liver failure. We present a case of CP successfully treated with dupilumab, a fully human monoclonal antibody that targets the IL-4 receptor α subunit.A 37-year-old man was in his usual state of health when hepatic cholestasis was noted on routine bloodwork. MRI/MRCP imaging revealed biliary ductal changes in the bilateral hepatic ducts, and liver biopsy showed prominent portal lymphoplasmacytic infiltrate, interface hepatitis, and stage II fibrosis–consistent with primary sclerosing cholangitis (PSC)/autoimmune hepatitis (AIH) overlap. The patient’s liver disease remained stable on azathioprine until age 39 when he developed worsening cholestasis (total bilirubin 7.8 mg/dL) with severe pruritus. ERCP revealed a markedly narrowed common bile duct, and a stent was placed. Cholestasis (total bilirubin 2.2 mg/dL) and pruritus improved over the next few months, and upon stent removal his pruritus was initially well controlled with daily