Nemolizumab has a rapid onset of action in prurigo nodularis, as represented by improvement in sleep and itch reduction within 48 hours of administration.
Individuals with prurigo nodularis tend to experience multiple itchy nodules, sleep disturbances, and a poor quality of life. Nemolizumab is an interleukin 31 α receptor (IL-31AR) inhibitor that positively affects prurigo nodularis by modulating neuroimmune responses.
Stander et al. conducted a post hoc analysis of a phase 2 clinical trial in order to assess the action of nemolizumab on sleep disturbances and itch in prurigo nodularis patients. The study’s findings are published in the Journal of the European Academy of Dermatology and Venereology.
This study comprised 70 patients, including 36 in the placebo group and 34 in the nemolizumab group. Approximately 60% of the study participants had between 20 and 100 nodules, and the remaining had more than 100 nodules. The peak pruritus numerical rating scale (PP-NRS) score was 8.4 at baseline.
Onset of Action of Nemolizumab for Itch Relief
Patients administered nemolizumab demonstrated a significantly greater reduction in itch compared to the placebo group patients within 48 hours. There was a significant difference between the two groups regarding the ≥ 4-point reduction in the PP-NRS on Day 3, with approximately 23.5% of the patients in the nemolizumab group meeting the response criteria compared to 0% of patients in the placebo group.
Onset of Action of Nemolizumab for Sleep Improvement
Itch relief was associated with improvement in sleep. There was a significant difference across the nemolizumab and placebo groups based on the sleep disturbance numerical rating scale (SD-NRS) by Day 4. A greater number of participants from the nemolizumab group reported a decrease of ≥ 4 points SD-NRS by the second day.
Association Between Baseline Characteristics and Study Outcomes
The onset of itch relief was slower for patients with atopy, and itch reduction was less for patients with Investigator Global Assessment (IGA) scores of 4 and those with ≥ 8 PP-NRS at baseline. The onset of action was more rapid in patients with between 20 and 100 lesions at baseline than those with > 100 lesions at baseline; however, by days 5–6, the reduction in itch was comparable regardless of the lesion count at baseline.
Ständer, S., Yosipovitch, G., Jp, L., Legat, F. J., Paul, C., Reich, A., Chaouche, K., Ahmad, F., & Piketty, C. (2022). Nemolizumab efficacy in prurigo nodularis: onset of action on itch and sleep disturbances. Journal of the European Academy of Dermatology and Venereology, 36(10), 1820–1825. https://doi.org/10.1111/jdv.18377