Baricitinib rapidly and sustainably relieves a patient from chronic pruritus of unknown origin refractory to dupilumab

Buttgereit, Thomas; Grekowitz, Eva Maria; Metz, Martin

doi:10.1016/j.jdcr.2021.06.028

Cited by 5 publications

(5 citation statements)

References 10 publications

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“…CPUO also signals through similar pathways, with IL-31 being a major player in its pathogenesis . The findings of this study are in line with case reports and series showing a response to JAK inhibitors among patients with CPUO . Patients with CPUO may have variable degrees of neural and immune dysregulation, and those with more inflammatory disease may respond better to immunomodulatory therapy .…”

Section: Discussionsupporting

confidence: 86%

“…40 The findings of this study are in line with case reports and series showing a response to JAK inhibitors among patients with CPUO. 27,28 Patients with CPUO may have variable degrees of neural and immune dysregulation, and those with more inflammatory disease may respond better to immunomodulatory therapy. 25 Although differences in baseline immunoglobulin E, eosinophils, and diabetes status between CPUO responders and nonresponders did not reach statistical significance in this small cohort, we suspect that larger studies will help characterize subpopulations within CPUO who respond most favorably to JAK inhibitors.…”

Section: Discussionmentioning

confidence: 99%

“…CPUO remains poorly understood. However, subsets of patients with CPUO feature type 2 inflammatory dysregulation with increased biomarkers such as blood eosinophils and immunoglobulin E, suggesting a role for JAK1 in its pathogenesis . Given the limited therapeutic options for these conditions and the aforementioned rationale for JAK1 inhibition, we initiated a phase 2, open-label clinical trial to evaluate the JAK1 inhibitor abrocitinib in the treatment of patients with PN and CPUO.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Abrocitinib in Prurigo Nodularis and Chronic Pruritus of Unknown Origin

Kwatra,

Bordeaux,

Parthasarathy

et al. 2024

JAMA Dermatol

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ImportancePrurigo nodularis (PN) and chronic pruritus of unknown origin (CPUO) are chronic pruritic diseases that dramatically impair quality of life, but therapeutic options are limited. Abrocitinib, a Janus kinase 1 inhibitor, represents a promising therapy for both conditions.ObjectiveTo assess the efficacy and safety of 200-mg oral abrocitinib administered once daily in adults with moderate to severe PN or CPUO.Design, Setting, and ParticipantsThis phase 2, open-label, nonrandomized controlled trial conducted between September 2021 and July 2022 took place at a single center in the US. A total of 25 adult patients with moderate to severe PN or CPUO were screened. Ten patients with PN and 10 patients with CPUO were enrolled. All 20 patients completed the 12-week treatment period, 18 of whom completed the 4-week follow-up period.InterventionAbrocitinib, 200 mg, by mouth once daily for 12 weeks.Main Outcomes and MeasuresThe primary efficacy end point was the percent change in weekly Peak Pruritus Numerical Rating Scale (PP-NRS) scores from baseline to week 12. Key secondary end points included the percentage of patients achieving at least a 4-point reduction in weekly PP-NRS score from baseline to week 12 and the percent change in Dermatology Life Quality Index (DLQI) scores.ResultsA total of 10 patients with PN (mean [SD] age, 58.6 [13.1] years; all were female) and 10 patients with CPUO (mean [SD] age, 70.7 [5.6] years; 2 were female) enrolled in the study. The mean (SD) baseline PP-NRS score was 9.2 (1.0) for PN and 8.2 (1.2) for CPUO. PP-NRS scores decreased by 78.3% in PN (95% CI, −118.5 to −38.1; P &lt; .001) and 53.7% in CPUO (95% CI, −98.8 to −8.6; P = .01) by week 12. From baseline to week 12, 8 of 10 patients with PN and 6 of 10 patients with CPUO achieved at least a 4-point improvement on the PP-NRS. Both groups experienced significant improvement in quality of life as demonstrated by percent change in DLQI scores (PN: −53.2% [95% CI, −75.3% to −31.1%]; P = .002; CPUO: −49.0% [95% CI, −89.6% to −8.0%]; P = .02). The most common adverse event among patients was acneiform eruption in 2 of 20 patients (10%). No serious adverse events occurred.Conclusions and RelevanceThe results of this nonrandomized controlled trial suggest that abrocitinib monotherapy may be effective and tolerated well in adults with PN or CPUO. Randomized, double-blind, placebo-controlled trials are warranted to validate these findings.Trial RegistrationClinicalTrials.gov Identifier: NCT05038982

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Abrocitinib in Prurigo Nodularis and Chronic Pruritus of Unknown Origin

Kwatra,

Bordeaux,

Parthasarathy

et al. 2024

JAMA Dermatol

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“…The itch-scratch cycle results in skin damage and increased risk of cutaneous infections that already pose a threat in DD. Clinical trials in atopic dermatitis demonstrate that treatment with baricitinib induces rapid improvement in itch and sleep disturbances, and there are also reports of benefit in chronic pruritus of unknown origin . Therefore, baricitinib might have a role in pruritus relief independently from its etiology by inhibiting the downstream JAK signaling that modulates sensory nerves …”

Section: Discussionmentioning

confidence: 99%

Response of Darier Disease Following Treatment With Baricitinib

et al. 2022

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“…In clinical trials, treatment with baricitinib demonstrated a rapid and a signifcant reduction in pruritus among patients with atopic dermatitis, observed as early as one day following the initial dose [9,10]. Several case reports showed that baricitinib could be a good candidate for treating refractory PN and chronic pruritus, including those who had failed dupilumab [11][12][13][14]. To the best of our knowledge, no earlier study has been conducted to investigate the beneft of baricitinib in patients with PN.…”

Section: Introductionmentioning

confidence: 99%

Baricitinib for Prurigo Nodularis: A Pilot Study on Efficacy and Safety

Pongcharoen,

Tuchinda,

Chakkavittumrong

et al. 2024

Dermatologic Therapy

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Background. Breaking the itch-scratch cycle and facilitating lesion healing are pivotal in managing prurigo nodularis (PN). This study seeks to assess the efficacy of baricitinib, an oral JAK1/2 inhibitor, for treating PN. Methods. In this prospective pilot study, 12 patients with moderate to severe PN were administered oral baricitinib at a dosage of 4 mg/day for 12 weeks. The primary objective was to assess the efficacy of baricitinib in PN patients using the numeric rating scale (NRS) for pruritus, NRS sleep score, a 5-point investigator’s global assessment (IGA) scale, dermatology life quality index (DLQI), and nodular lesion count at weeks 0, 1, 2, 4, 8 and 12. In addition, the NRS pruritus and sleep scores were assessed via phone on days 2 and 4 after baricitinib treatment. Results. Baricitinib treatment led to a statistically significant improvement in the mean NRS pruritus and sleep scores, evident as early as day 2 (57.7% change from baseline; P<0.001, and 34.7% change from baseline, P=0.029, respectively) and consistently declining thereafter. Evaluation of nodular lesions revealed a significant reduction starting from week 2 (mean difference of 37.08 from baseline; P<0.001). Analysis of other endpoints, including mean DLQI and IGA scores, also demonstrated substantial improvement at all time points (week 1, 2, 4, 8, and 12) compared to baseline. However, it is important to acknowledge the limitation of a small sample size. This constraint warrants consideration when interpreting the results and generalizing the findings. Conclusion. This preliminary study underscores baricitinib’s potential for PN treatment by providing a rapid clinical response. The larger and longer randomized controlled trials are essential to determine the effectiveness, longevity, and safety of baricitinib in managing PN. This trial is registered with TCTR20230227002.

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Baricitinib rapidly and sustainably relieves a patient from chronic pruritus of unknown origin refractory to dupilumab

Cited by 5 publications

References 10 publications

Efficacy and Safety of Abrocitinib in Prurigo Nodularis and Chronic Pruritus of Unknown Origin

Efficacy and Safety of Abrocitinib in Prurigo Nodularis and Chronic Pruritus of Unknown Origin

Response of Darier Disease Following Treatment With Baricitinib

Baricitinib for Prurigo Nodularis: A Pilot Study on Efficacy and Safety

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