Background
Atopic dermatitis (AD) is a chronic, inflammatory skin condition affecting up to one-quarter of children. Uncontrolled pruritus associated with childhood AD, and the accompanying scratching, negatively impacts quality of life (QoL), sleep, and development. The humanised monoclonal antibody nemolizumab, used concomitantly with topical agents, was shown to reduce pruritus and improve QoL in patients with AD aged ≥13 years. However, data relating to its efficacy and safety in younger children (aged <13 years) have been lacking.
Objective
To evaluate the efficacy and safety of nemolizumab, administered concomitantly with topical agents, in Japanese paediatric patients (aged 6–12 years) with AD and inadequately controlled moderate-to-severe pruritus.
Method
This was a randomised, placebo-controlled, double-blind, parallel-group, multicentre, 16-week, phase III study. Patients aged ≥6 and <13 years, with confirmed AD, and an inadequate pruritic response despite treatment with topical agents and oral antihistamines were randomly assigned (1:1) to receive nemolizumab 30 mg or placebo every 4 weeks (Q4W). The primary efficacy end point was the change in the weekly mean 5-level itch score from baseline to week 16; secondary efficacy endpoints were related to pruritus, indicators for AD, and QoL. Safety was assessed via adverse events (AEs) and laboratory test results.
Results
In total, 89 patients were enrolled, received either nemolizumab 30 mg (n = 45) or placebo (n = 44) Q4W, and completed the study. Mean patient age was 9·1 (standard deviation 1·9) years, and mean duration of AD was 8·5 (2·7) years. The change in 5-level itch score from baseline to week 16 showed a statistically significant difference in the nemolizumab treatment group (−1·3) compared with placebo (−0·5; least-squares mean difference −0·8, 95% confidence interval, −1·1 to −0·5; P < 0·0001). Improvements with nemolizumab were observed from the second day of administration. Secondary endpoints were in favour of nemolizumab. No AEs resulted in discontinuation, and the overall safety profile in patients aged 6–12 years was comparable with that in older patients (aged ≥13 years) with AD.
Conclusions
Nemolizumab is a potential new treatment option for paediatric AD patients whose pruritus has not been sufficiently improved with topical treatments and antihistamines.