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A recent review confirmed the clinical effectiveness of dupilumab for treating prurigo nodularis, as represented by significant decreases in numeric rating scale itch intensity scores and high safety ratings in prurigo nodularis patients with no serious adverse events.

The conventional therapeutic approaches in the management of prurigo nodularis have high side effect profiles and limited clinical efficacy. Dupilumab is an interleukin (IL)-13 and IL-4 signaling inhibitor that binds to the IL-4 Rα subunit, which is shared by IL-13 and IL-4. The drug has been approved by the Food and Drug Administration (FDA) for the treatment of prurigo nodularis in adult patients. 

This systematic review assessed the clinical efficacy and safety of dupilumab in prurigo nodularis patients. The findings are published in the journal Frontiers in Immunology.

Characteristics of Included Studies

This systematic review included a total of 24 studies, consisting of one prospective study, 13 case reports, five retrospective studies, and five case series. A total of 119 patients were included in the review, and the mean age of the patients was 53.9 years, with a range of 9–87 years. The majority of the patients were female, and the mean age of onset of prurigo nodularis was calculated to be 45.8 years, with a range of 6–83 years.

Past Treatment Strategies in Prurigo Nodularis Patients

All the patients included in this review had previously received a minimum of one treatment strategy, and all strategies had failed. The previous treatment strategies included phototherapy, immunosuppressants, systemic and topical corticosteroids, cryotherapy, apremilast, antihistamines, antibiotics, phototherapy, thalidomide, systemic retinoids, dronabinol, cannabidiol, and lenalidomide. Failed therapeutic approaches also included antidepressants and opioid antagonists.

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Dupilumab and Prurigo Nodularis Remission

After 4 weeks of treatment with dupilumab, approximately 8.3% of the patients demonstrated complete remission, whereas approximately 85.0% experienced partial remission. No remission following treatment with dupilumab was observed in approximately 6.7% of the patients. The numeric rating scale itch intensity (NRSI) significantly reduced from 9 to 4.9. The NRSI decreased to 4.9, 2.1, 2.8, and 0.9 at 4, 12, 16, and more than 16 weeks of treatment with dupilumab, respectively.

Safety Profile of Dupilumab in Prurigo Nodularis Patients

Of the total patients, 61.3% experienced no adverse events following treatment with dupilumab. On the contrary, no information pertaining to adverse events was available for 21% of the total patients. The remaining patients experienced different adverse events, such as conjunctivitis, herpes labialis, dry eyes, eosinophilia, arthralgias, injection site reaction, and shingles.

Source

Cao, P., Xu, W., Jiang, S., & Zhang, L. (2023). Dupilumab for the treatment of prurigo nodularis: A systematic review. Frontiers in Immunology, 14. https://doi.org/10.3389/fimmu.2023.1092685