Podcast: IBAT Inhibitors: Mechanism, Positioning, and Patient Selection

Join Oyin Penny and Janet Gripshover and explore the mechanism of action, treatment positioning, and patient selection for ileal bile acid transporter (IBAT) inhibitors in cholestatic pruritus, or itching associated with cholestatic liver disease. With a focus on primary biliary cholangitis (PBC), this podcast reviews how IBAT inhibitors limit intestinal bile acid reabsorption and promote excretion through stool, while distinguishing symptom-focused treatment from management of the underlying liver disease. The speakers discuss where itch-directed therapy may fit alongside ongoing PBC treatment and why assessing symptoms is important even when liver tests improve. The conversation highlights how persistent itching can disrupt sleep, work, daily activities, and quality of life, particularly when patients have come to accept their symptoms as normal. Additional topics include diarrhea and gastrointestinal tolerability, considerations for patients with advanced liver disease or preexisting bowel symptoms, and insurance coverage and step therapy barriers. Janet and Oyin also emphasize shared decision-making, setting treatment expectations, monitoring benefits and side effects, and incorporating routine itch questions into clinical visits and electronic health record templates. Designed for nurse practitioners, physician assistants, and other gastroenterology and hepatology professionals, this episode offers practical perspectives on individualized cholestatic pruritus management, patient education, and looking beyond laboratory values to address what matters most to patients.