18 November 2025
: Case report 
Exploring Maralixibat for Treatment-Resistant Pruritus in Intrahepatic Cholestasis of Pregnancy and Primary Biliary Cholangitis: A Case Report
Unusual clinical course, Challenging differential diagnosis, Unusual setting of medical care, Patient complains / malpractice, Adverse events of drug therapy, Educational Purpose (only if useful for a systematic review or synthesis)
Lara Alexandra Bersuch
ABCDEF 1*, Andrea De Gottardi DE 1,2
DOI: 10.12659/AJCR.949019
Am J Case Rep 2025; 26:e949019
Table 1 Laboratory parameters, clinical events, and medication during pregnancy and postpartum.
| Week of gestation/ day postpartum | Bilirubin total (μmol/L) | sBA (μmol/L) | AST (U/L) | ALT (U/L) | ALP (U/L) | VAS Score | Medication events |
|---|---|---|---|---|---|---|---|
| 19 | 51 | 213 | 160 | 269 | – | 8 | Start UDCA |
| 20 | 84 | 133 | 220 | 313 | 231 | 8 | |
| 20 | 69 | 169 | 62 | 148 | 217 | 8 | |
| 22 | – | 144 | – | – | – | 8 | |
| 24 | 37 | 204 | 96 | 183 | 288 | 8 | |
| 25 | 33 | 272 | 85 | 168 | 294 | 8 | |
| 27 | 25 | 190 | 78 | 172 | 344 | 8 | |
| 29 | 24 | 121 | 98 | 224 | 377 | 8 | |
| 30 | 22 | 48.5 | 79 | 162 | 374 | – | Start maralixibat |
| 31 | 24 | 38.6 | 53 | 95 | 367 | 3 | |
| 32 | 30 | 63 | 52 | 88 | 369 | 3 | |
| 32 | 22 | 91.1 | 35 | 60 | 385 | 0 | |
| 32 | 26 | 63 | 55 | 75 | 467 | 0 | |
| 34 | 24 | 77.8 | 42 | 72 | 419 | 1 | |
| 34 | 22 | 58.4 | 46 | 62 | 442 | 2 | |
| 35 | 28 | 110 | 55 | 78 | 497 | 3 | |
| 35 | – | – | 73 | 100 | – | 3 | Labor |
| Day 2 postpartum | 27 | – | 80 | 117 | – | 3 | Stop maralixibatContinue UDCA |
| Day postpartum | 20 | 80.1 | 83 | 130 | 568 | – | |
| Serial measurements of total bilirubin, serum bile acids (sBA), aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and pruritus intensity (Visual Analog Scale, VAS) are shown at various gestational weeks and postpartum time points. Missing values are indicated by “−”. VAS, Visual Analog Scale for pruritus intensity; UDCA, ursodeoxycholic acid. | |||||||