Rifampicin in the treatment of severe intrahepatic cholestasis of pregnancy

Victoria Geenes; Jenny Chambers; Rshmi Khurana; Elisabeth Wikstrom Shemer; Winnie Sia; Dalvinder Mandair; Elwyn Elias; Hanns-Ulrich Marschall; William Hague; Catherine Williamson

doi:10.1016/j.ejogrb.2015.03.020

Rifampicin in the treatment of severe intrahepatic cholestasis of pregnancy

Eur J Obstet Gynecol Reprod Biol. 2015 Jun:189:59-63. doi: 10.1016/j.ejogrb.2015.03.020. Epub 2015 Mar 28.

Authors

Affiliations

¹ Women's Health Academic Centre, King's College London, London, United Kingdom.
² Women's Health Research Centre, Imperial College London, London, United Kingdom.
³ Royal Alexandra Hospital, University of Alberta, Edmonton, Canada.
⁴ Department of Women's and Children's Health, Akademiska Hospital, Uppsala University, Uppsala, Sweden.
⁵ Liver Unit, University of Birmingham Trust Hospital, Birmingham, United Kingdom.
⁶ Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁷ Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.
⁸ Women's Health Academic Centre, King's College London, London, United Kingdom. Electronic address: [email protected].

PMID: 25864112
DOI: 10.1016/j.ejogrb.2015.03.020

Abstract

Objective: To describe the use of combined ursodeoxycholic acid (UDCA) and rifampicin treatment in intrahepatic cholestasis of pregnancy (ICP).

Study design: A questionnaire survey of 27 women with 28 affected pregnancies identified via the UK and International Obstetric Medicine forum. The clinical case notes of women with ICP treated with combined UDCA and rifampicin therapy were reviewed, and data regarding maternal and perinatal outcomes extracted.

Results: Serum bile acids remained high whilst taking UDCA as monotherapy. In 14 pregnancies (54%) serum bile acids decreased following the introduction of rifampicin. In 10 pregnancies (38%), there was a 50% reduction in serum bile acids. There were no adverse effects reported with either drug.

Conclusions: This is the first report of the use of rifampicin in ICP. The data suggest that combined treatment with UDCA and rifampicin is an effective way of treating women with severe ICP who do not respond to treatment with UDCA alone.

Keywords: Bile acids; Obstetric cholestasis; Pregnancy; Rifampicin; Ursodeoxycholic acid.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Bile Acids and Salts / blood
Cholestasis, Intrahepatic / blood
Cholestasis, Intrahepatic / drug therapy*
Drug Therapy, Combination
Female
Gestational Age
Humans
Pregnancy
Pregnancy Complications / blood
Pregnancy Complications / drug therapy*
Pregnancy Outcome
Rifampin / administration & dosage
Rifampin / therapeutic use*
Ursodeoxycholic Acid / administration & dosage

Substances

Bile Acids and Salts
Ursodeoxycholic Acid
Rifampin

Supplementary concepts

Intrahepatic Cholestasis of Pregnancy