Phototherapy versus pregabalin in treatment of chronic kidney disease associated pruritus: randomized controlled study

Background Chronic kidney disease-associated pruritus (CKD-AP) is a challenging disorder with unsatisfactory treatment response. The exact pathophysiology is unknown. Phototherapy and pregabalin are commonly used treatment options. Narrow band-ultraviolet B (NB-UVB) acts by inhibition of Langerhans cells, modulation of interleukin production, and induction of apoptosis of mast cells. Pregabalin acts by suppressing presynaptic glutamate release through inhibition of calcium currents via high-voltage active channels, leading to reduced neurotransmitter release and attenuation of postsynaptic excitability. Objective To compare the safety and efficacy of NB-UVB versus pregabalin in the treatment of refractory CKD-AP. Patients and methods A prospective randomized controlled study included 40 patients on maintenance hemodialysis with refractory pruritus. Patients were randomized into two groups: group A (20 patients) received two sessions of NB-UVB per week for a period of 2 months, and group B (20 patients) received pregabalin (50 mg after each dialysis session) for 2 months. The results of the present study were assessed by total 5-D itch score (after 4, 8, and 12 weeks). Results Both groups showed significant reduction in itching severity by the end of treatment (week 8) but recurrence of symptoms during follow-up (week 12) was observed, with no significant difference between both groups. However, fewer adverse effects, earlier onset of response, and less tendency of recurrence were observed in the NB-UVB group. Conclusion NB-UVB and pregabalin are both effective options in controlling refractory CKD-AP. Rapid control and delayed recurrence of symptoms favor NB-UVB.