The quality of evidencce is downgraded by imprecise results (few patients and wide confidencce intervals).
A Cochrane review [Abstract] 1 included 91 studies with a total of 4 652 adult subjects with 51 different treatments for pruritus in 4 different patient groups: uraemic pruritus (n=3 894), cholestatic pruritus (n=692), palliative care patients with pruritus of different origin (n=26), and pruritus as a symptom associated with HIV (n=40).
Uraemic pruritus (UP): GABA-analogues (gabapentin and pregabalin) reduced pruritus compared to placebo (VAS from 0 to 10 cm: MD −5.10, 95% CI −5.56 to −4.55; 5 studies, n=297).The effects of other treatments were moderate or minor: kappa-opioid agonists (difelikefalin, nalbuphine, nalfurafine), montelukast, fish-oil/omega-3 fatty acids, cromolyn sodium (oral rather than topical) and topical capsaicin.
Cholestatic pruritus (CP): Naltrexone compared to placebo reduced pruritus (VAS from 0 to 10 cm: MD −2.42, 95% CI −3.90 to −0.94; 2 studies, n=52). Rifampicin (VAS from 0 to 100, MD −42.00, 95% CI −87.31 to 3.31; 2 studies, n=42) and flumecinol (RR 2.32, 95% CI 0.54 to 10.1; 2 studies, n=69) tended to reduced pruritus compared to placebo, but the differences were not statistically significant.
Palliative care participants with pruritus of a different nature:Paroxetine, a selective serotonin reuptake inhibitor, compared to placebo reduced pruritus slightly (numerical analogue scale from 0 to 10 points: MD -0.78 95% CI −1.19 to −0.37; 1 study, n=48).
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