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Management of Fatigue in Primary Biliary Cholangitis

Lookup NU author(s): Dr Amardeep Khanna, Dr Vinod Hegade, Professor David Jones



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Fatigue in primary biliary cholangitis patients is a frequently encountered and often debilitating symptom. With no currently approved drug therapies available to target fatigue as a symptom, managing these patients can be very challenging in a day-to-day clinical practise. We have critically appraised currently available evidence on various pharmacological agents trialled in the management of fatigue in PBC.Most recently, a randomised controlled trial from Newcastle group using Rituximab in high fatigue patients has shown equivocal results for the improvement of fatigue, with a significant placebo effect. The data suggest that the general use of Rituximab for the treatment of fatigue in PBC is not supported; however, there was evidence suggesting improvement of muscle metabolic dysfunction linked to peripheral fatigue, and it may be that the agent has value in a carefully selected subgroup of patients with, in particular, peripheral fatigue. Further work is needed in this area. In addition, there are several non-pharmacological interventions which are available and can be considered in management of fatigue in PBC patients.A combination of non-pharmacological and currently non-licenced pharmacological therapies may be required in managing fatigue in PBC patients.

Publication metadata

Author(s): Khanna A, Hegade VS, Jones DE

Publication type: Review

Publication status: Published

Journal: Current Hepatology Reports

Year: 2019

Volume: 18

Pages: 127-133

Online publication date: 23/05/2019

Acceptance date: 23/05/2019

ISSN (electronic): 2195-9595


DOI: 10.1007/s11901-019-00458-0