An internal itch that won’t let you focus, sleep, or go about your usual daily activities can be exhausting. For people with primary biliary cholangitis (PBC), cholestatic pruritus can cause persistent, sometimes severe itching.

“I itch all over my body, and it all feels like something crawling under or over my skin most of the time. Drives me crazy not knowing if something is there or not,” said a member of myPBCteam.

If you’re starting linerixibat (Lynavoy), you may wonder how soon it could start relieving your itch. This article will cover how long it takes linerixibat to work, what the research says, what to expect, and when to call your doctor.

How Long Does Linerixibat Take To Work?

Cholestatic pruritus is itching associated with reduced or blocked bile flow. It can affect your whole body but commonly affects the hands and feet. Linerixibat is an ileal bile acid transporter (IBAT) inhibitor that reduces the reabsorption of bile acids in the small intestine, allowing more bile acids to leave the body in stool.

Clinical trials suggest that linerixibat can reduce itching within the first few weeks. In the phase 3 GLISTEN trial, people taking linerixibat had greater improvement in itching than those taking placebo by week 2. That improvement continued over the next 24 weeks.

What the GLISTEN Trial Found About Itch Relief

The GLISTEN trial was a study of 238 adults with PBC with moderate to severe itching. People received either linerixibat 40 milligrams twice daily or a placebo (inactive treatment used for comparison) for six months. The Worst Itch Numerical Rating Scale (WI-NRS) was used to describe how bad their itching was.

The WI-NRS is a zero- to 10-point scale in which a score of zero means no itching and a score of 10 means the worst imaginable itching. People recorded their itch using this scale regularly, allowing researchers to calculate weekly and monthly itch scores.

At week 2, people taking linerixibat had an average 1.78-point decrease in their weekly itch score, compared with a 1.07-point decrease in the placebo group. This suggested that linerixibat was already helping reduce itching by week 2.

At 24 weeks, the average monthly itch score decreased by 2.86 points for people taking linerixibat compared with 2.15 points for people taking placebo.

What To Expect During the First Few Weeks

During the first several weeks of taking linerixibat, take it as prescribed and watch for drug interactions, changes in your itching, and changes in your sleep or how you feel overall.

Linerixibat is approved by the U.S. Food and Drug Administration (FDA) to treat cholestatic pruritus associated with PBC in adults. The recommended dose is 40 milligrams twice daily. It should be taken at least 30 minutes before food or any beverage other than water.

Some medications that you may already take for PBC-related pruritus may interact with linerixibat. If you take bile acid-binding resins, such as cholestyramine (Questran), it’s important to take linerixibat at least four hours before or four hours after the resin.

During the first few weeks, pay attention to whether your itch is decreasing and how it’s affecting your daily life. PBC-related itching can affect your sleep, making it harder for you to fall asleep or stay asleep.

Sleep interference and fatigue can have an impact on your quality of life. Improvements in nighttime itching may lead to better sleep, which can make a meaningful difference in your day-to-day life and well-being.

Linerixibat Side Effects

Side effects, especially in the first few weeks of starting linerixibat, are something to watch for.

About 61 percent of people had diarrhea when taking linerixibat compared to 18 percent of people taking placebo.

Diarrhea is more common when you begin treatment with linerixibat and may get better with time. Other side effects that some people experience while taking linerixibat include:

• Abdominal pain
• Nausea
• Gastroesophageal reflux disease (GERD)
• Increased alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels
• Headache
• Dizziness
• Joint pain

Linerixibat can also reduce the body’s absorption of fat-soluble vitamins, including vitamins A, D, E, and K. The prescribing information recommends checking fat-soluble vitamin levels before and during treatment.

Vitamin deficiency may increase the risk of bleeding, and IBAT inhibitors have been associated with bone fractures. Talk to your doctor if you have unusual bleeding or a bone fracture while taking linerixibat.

Why Linerixibat May Help Cholestatic Pruritus

Linerixibat is an IBAT inhibitor. It works in the terminal ileum, the last part of the small intestine, where it blocks the reabsorption of bile acids. Normally, bile acids are reabsorbed and returned to the liver. By blocking this process, linerixibat allows more bile acids to leave the body in stool.

Researchers believe that this change in bile acid reabsorption may help reduce itching. However, the exact mechanism by which linerixibat improves itching is not yet known.

Research has found changes in several biomarkers during linerixibat treatment, and some of these changes were linked with less itching. However, researchers do not yet fully understand exactly how linerixibat relieves PBC-related itch.

Linerixibat may help reduce PBC itch within the first few weeks, and studies found that improvements lasted through 24 weeks of treatment.

What If Your Itch Doesn’t Improve?

If you don’t notice a change after a few days of taking linerixibat, it doesn’t mean it isn’t working. In clinical studies, improvements in PBC-related itching were seen starting after around two weeks. It may take some time before you notice a difference.

The GLISTEN trial followed patients for six months and found that improvements in PBC-related itching were maintained over time. Over six months, linerixibat also improved itch-related sleep interference.

Look for signs of improvement during the first few weeks, but keep in mind that it may take longer to feel the full benefit. If your itching isn’t getting better as expected, talk to your doctor.

Let your doctor know if you have side effects that become bothersome or become worse over time. For example, diarrhea that’s severe or continues over a long period of time can lead to dehydration. It’s important to let your doctor know if this happens.

Linerixibat is an FDA-approved treatment option for adults with cholestatic pruritus associated with PBC.

It may be considered along with other treatment options based on your symptoms, other medications, and your doctor’s recommendations.

Read more about PBC treatment options ❯