COMPARATIVE EFFICACY OF URSODEOXYCHOLIC ACID AND DEXAMETHASONE IN REDUCING SEVERE PRURITUS IN PATIENTS WITH INTRAHEPATIC CHOLESTASIS OF PREGNANCY

JPUMHS; 2024:14:04, 243-249. http://doi.org/10.46536/jpumhs/2024/14.04.581

Abstract

BACKGROUND: Intrahepatic cholestasis of pregnancy (ICP) is a hepatobiliary condition
associated with impaired bile acid flow, which results in heavy maternal pruritus and an increased
risk of adverse fetal outcomes such as preterm birth and stillbirth. Ursodeoxycholic acid (UDCA)
is the first-line therapy, which reduces levels of bile acids and alleviating symptoms. In some cases
a poor response to UDCA necessitates additional therapies. Dexamethasone, a corticosteroid, had
been proposed as an alternative, however its use during pregnancy remains controversial and
concerns exist regarding both its efficacy and safety. OBJECTIVE: To compare the efficacy and
safety of ursodeoxycholic acid (UDCA) and dexamethasone in reducing severe pruritus in
pregnant women diagnosed with intrahepatic cholestasis of pregnancy (ICP). MATERIAL &
METHODS: This was a comparative, prospective study carried out in the Gynecology
Department of Hayatabad Medical Complex, Peshawar, from June 2022 to May 2023. A total of
155 pregnant women with ICP whose diagnosis was based on clinical presentation of pruritus and
elevated serum bile acid levels (>10 µmol/L) after the 20th week of gestation were included in this
study. RESULTS: VAS pain scores decreased significantly in both groups over 4 weeks, however
Group A (UDCA) diminished to a greater extent at all time points. At Week 1, the VAS score in
Group A was lower than in Group B (6.2 ± 0.9 in group A vs. 7.1 ± 1.0 in group B). By Week 4,
Group A mean VAS pain score decreased to 2.1 ± 0.6 and was significantly lower than Group B
3.9 ± 0.8. CONCLUSION: In patients with ICP, UDCA showed substantially superior efficacy
compared to dexamethasone with respect to severe pruritus and serum bile acid levels. The UDCA
group had better maternal and fetal outcomes, as well as a more favorable safety profile confirming
its place as the first-line therapy for ICP management.