Patients were further instructed to call the principal investigator when necessary. The intensity of symptoms was quantified by means of visual analogue scales (VASs) in the morning and in the evening. The pruritus VAS score varied from score 0 (no pruritus) to 10 (severe pruritus). Fatigue and quality of sleep were evaluated with comparable VAS scores. Patients were asked to begin completing the pruritus VAS scores 7 days before the actual start of treatment (day 0). The severity Venetoclax mw of pruritus was

further quantified by open categorized questions and by descriptions of the nature and extent of cutaneous scratch lesions, which were classified as follows: (1) excoriations (mild), (2) plaques (moderate), (3) nodules (severe), or (4) indifferent scars. Additionally, with identical cameras with the same settings, photographs were taken from the

front and back of the extremities and the trunk before treatment and at the end of treatment. The severity of skin lesions was scored on the basis of these photographs U0126 mw by an experienced dermatologist (H.B.T.) who was blinded with respect to the treatment allocation and sequence of photographs. The participants completed two validated quality-of-life scores (Short Form 36 and Liver Disease Symptom Index 2.0) before and after treatment.16, 17 Finally, laboratory investigations, including measurements of the total serum bile acid, total bilirubin, albumin, alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase levels, were performed before and at the end of treatment. Possible adverse events were assessed after 7 and 21 days of treatment. When patients were using ursodeoxycholic acid, this treatment was continued. To prevent interference with the absorption of ursodeoxycholic acid and other drugs including levothyroxine, glyburide, and oral contraceptives, a minimal interval of 4 hours between the intake of the

study medication and these drugs was advised. Antipruritic drugs other than the study medication were stopped with a washout period of at least 3 weeks. However, patients were allowed to continue rifampicin and naltrexone at a stable dose if they medchemexpress felt these agents were of (some) benefit. No other antipruritic drug was allowed during the trial when patients experienced worsening of pruritus. The predefined primary endpoint of this study was the proportion of patients per group with at least a 40% reduction of pruritus based on VAS scores; this was based on a comparison of the mean scores on days 18, 19, and 20 with the mean scores on days −2, −1, and 0. Secondary endpoints were an improvement in quality-of-life scores and a reduction in the severity of scratch lesions after 21 days in comparison with pretreatment scores. The power calculation (Fisher’s exact test) was based on the primary outcome of a 40% reduction in the severity of pruritus. On the basis of a study of Mayo et al.