SP150EFFICACY OF DESLORATADINE VERSUS BILASTINE ON UREMIC PRURITUS IN PATIENTS WITH END STAGE RENAL DISEASE

Abstract

INTRODUCTION: Uremic pruritus is a common symptom in end stage renal disease patients with a prevalence ranging from 20% to 50%. Although its incidence has been reduced in recent years as a result of dialysis methods efficacy, pruritus remains a serious problem causing severe discomfort often in association with decreased quality of life. Histamine released from mast cells has been implicated in the pathogenesis of uremic pruritus. The aim of this study was to investigate the efficacy of antihystamine factors Bilastine versus Desloratadine, both second generation selective histamine H1 receptor antagonists, in patients with dialysis depended end stage renal disease and uremic pruritus. METHOD(S): This was a prospective open label study. Patients on hemodialysis and peritoneal dialysis were screened for the presence of uremic pruritus using the standardized 5-D scale questionnaire. The 5-D questionnaire is used to quantify duration, degree, direction, disability and direction of itch with a score ranging between 5 (no pruritus) and 25 (most severe pruritus). Identified patients with uremic pruritus were randomly assigned to receive treatment in 1:1 ratio with either desloratadine (5 mg) or bilastine (20 mg) once daily for one month. After one month patients were re-evaluated using the 5-D scale questionnaire. Baseline laboratory parameters like hemoglobin, serum calcium, phosphorus, intact parathormone, 25-OHvitamin D, C reactive protein and Ca-P product were also evaluated. All patients gave a written informed consent before entering the study. RESULT(S): Overall, 89 patients (47 on hemodialysis and 42 on peritoneal dialysis) with a mean age of 61,02+/-15,9 years (61 males) were evaluated for uremic pruritus. Among these, 20 patients were identified with uremic pruritus (prevalence 22,5%) and were assigned to receive treatment. 10 of them either refused to receive or discontinued treatment before the end of follow up. Finally, 10 patients (7 males) with a mean age of 66,5+/-12,9 years were included in the analysis (5 on desloratadine). Baseline laboratory values did not differ between patients with and without uremic pruritus or between the two groups prescribed the two different treatment regimens. 5-D itch score was not significantly different between those assigned to desloratadine and bilastine (13,4+/-4,8 vs 14+/-2,6 respectively, p=ns). After one month of treatment only those that received bilastine showed a significant improvement in 5-D itch score (14+/-2,6 vs 9,2+/-2,9, p=0,016) while patients that received desloratadine showed a non significant decrease (13,4+/-4,8 vs 11,8+/-5,6, p=ns). Improvement of symptoms in bilastine treated patients concerned all quantified pruritus parameters of 5-D itch score. No major adverse events were reported during follow up. CONCLUSION(S): Uremic pruritus continues to be an important every day problem in this cohort of dialysis depended patients. Bilastine prescription effectively decreased uremic pruritus symptoms as assessed with the 5-D itch scale.