Kondrackiene J et al. (2005) Efficacy and safety of ursodeoxycholic acid versus cholestyramine in intrahepatic cholestasis of pregnancy. Gastroenterology 129: 894–901

The optimal treatment of intrahepatic cholestasis of pregnancy (ICP)—a condition characterized by maternal pruritus that is associated with premature delivery, stillbirth and fetal distress—remains to be established. Ursodeoxycholic acid (UDCA) has been suggested as a treatment option for such patients; however, studies to date have been conflicting and there has been a lack of large, randomized trials. Kondrackiene and colleagues conducted a trial comparing the efficacy and safety of UDCA with cholestyramine in 84 women with symptomatic ICP at between 25 and 39 weeks of gestation.

Patients were randomized 1:1 to receive 14 days of treatment with either UDCA or cholestyramine. Results showed UDCA to be more effective in relieving pruritus than cholestyramine, with 67% of patients in the UDCA group achieving a reduction in pruritus score of >50%, compared with only 19% in the cholestyramine group. Patients in the UDCA group recorded significantly lower pruritus scores at 7 and 14 days of treatment than those receiving cholestyramine. Birthweights did not differ significantly between the groups and there were no stillbirths; however, patients delivered significantly closer to term in the UDCA group compared with the cholestyramine group. In addition, adverse events were experienced by 12 patients in the cholestyramine group and none in the UDCA group.

The authors conclude that UDCA is safer and more effective than cholestyramine as first-line therapy for ICP.