P1734 - Scratching the Surface: Successful Treatment of Severe Intrahepatic Cholestasis of Pregnancy With an Ileal Bile Acid Transporter Inhibitor (IBAT)
Oluwakemi Adewuyi, MD, Ashley Tran, MD Saint Luke's University Hospital, Bethlehem, PA Introduction: Intrahepatic cholestasis of pregnancy (ICP) is a rare, pregnancy-specific liver disorder characterized by intense pruritus and elevated serum bile acids during the third trimester of pregnancy. Elevated bile acid (BA) levels particularly > 40µmol/L carries significant risk of preterm birth and fetal demise. Current standard of care include treatment with ursodeoxycholic acid (UDCA) which may be insufficient in severe cases. We report a unique case of refractory ICP successfully managed with an ileal bile acid transporter (IBAT) inhibitor
Case Description/
Methods: A 29-year-old female with a history of ICP presented during her second pregnancy with abnormal liver tests and pruritus in her first trimester. She was diagnosed with ICP during her first pregnancy and required delivery via cesarean section at 35 weeks due to rising liver enzymes and total BA despite the use of UDCA and cholestyramine.
On initial presentation, AST 44 U/L, ALT 105 U/L, and BA 27 µmol/L. She was started on UDCA, cholestyramine and hydroxyzine. She completed a full serologic evaluation which was negative for viral hepatitis and autoimmune disease. She had a right upper quadrant ultrasound that was unremarkable. There was no evidence of preeclampsia. She underwent screening for genetic cholestatic conditions and was found to be heterozygous for the ABCB11 (c.2012-8T >G) gene. Despite maximal doses of UDCA, she continued to have worsening pruritus and rising BA with peak of 364 µmol/L in her third trimester.
After discussion with maternal fetal medicine, she received Odevixibat though expanded access. Within 7 days of starting therapy, her bile acids decreased 37 µmol/L and her pruritus significantly improved. She tolerated treatment without adverse events. She was closely monitored throughout the course of her pregnancy and delivered at 33 weeks due to intermittent elevations in her BA. She had resolution of her symptoms, normalization of her serum transaminases and improvement in BA to 11 µmol/L at one month post-partum. An ultrasound elastography was also negative for fibrosis. Discussion: IBAT inhibitors reduce enterohepatic circulation of BA and may offer rapid symptomatic and biochemical improvement for patients with cholestatic pruritus. While further study is needed, our case report demonstrated improvement in pruritus and serum BA in our patient with refractory ICP. This supports the need for potential for IBAT inhibitors as adjunctive therapy in select, high-risk ICP patient unresponsive to conventional therapy.
Disclosures: Oluwakemi Adewuyi indicated no relevant financial relationships. Ashley Tran indicated no relevant financial relationships.
Oluwakemi Adewuyi, MD, Ashley Tran, MD. P1734 - Scratching the Surface: Successful Treatment of Severe Intrahepatic Cholestasis of Pregnancy With an Ileal Bile Acid Transporter Inhibitor (IBAT), ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
