Efficacy of dupilumab in chronic prurigo and chronic idiopathic pruritus: a systematic review of current evidence and analysis of response predictors

Abstract

Dupilumab has demonstrated a great reduction in chronic pruritus that is the hallmark of atopic dermatitis (AD). Underscoring relevant pathogenesis similarities emerging from AD, chronic idiopathic pruritus (CIP) and chronic prurigo (CP), several authors suggested the beneficial role of dupilumab in these conditions. The evidence on this subject is limited with no precise data available. In this study, we carried out a systematic literature review in order to evaluate the efficacy of dupilumab on both pruritus and skin manifestations in the two largest retrospective cohorts of patients with CP and CIP and tried to identify potential response predictors. Electronic searches were conducted on 4 databases. Our primary outcome was the improvement in pruritus measured by a reduction in the patient's reported numerical rating scale of itch (NRSI) by >4. Secondary outcomes included the proportion of patients with a complete response at the end of treatment, reduction in the number of lesions by the Investigator Global Assessment (IGA), improvement in numerical rating scale of sleep (NRSS), improvement in quality of life measured by the Dermatology Life Quality Index (DLQI), time until patient perceived any improvement (Time-First) and time until the patient-reported absence of pruritus (Time-Final). Descriptive statistics were calculated for each demographic and clinical variable. Univariate logistic regression analyses were conducted to explore the association between response to dupilumab and potential predictive factors. We included 25 articles in the analysis, counting a total of 153 patients. Based on CP patients' cohort (n = 132), the mean NRSI at baseline was 8.79 AE 0.86 and the NRSI final was 2.32 AE 1.27. The mean time to first improvement was 5.18 AE 3.13 weeks, while the time to complete improvement of pruritus (Time-final) was 13.6 AE 12.0 weeks. Ninety patients out of 109 (83%) noticed an improvement in pruritus before 4 weeks of dupilumab therapy. At the end of treatment, 18 patients out of 126 (14%) had a complete remission of pruritus and 110 patients out of 123 (89%) had a reduction of NRSI >4. The reduction in NRSI was significantly greater in patients improving before 4 weeks of treatment (6.57 AE 1.71) compared with patients improving in more than 4 weeks (5.49 AE 1.39, P < 0.001). Patients with history of AD and those who have been previously treated with cyclosporine or methotrexate had a significantly lower reduction in NRSI (e.g. 6.05 AE 1.34 vs. 7.08 AE 1.90, P < 0.01 for nonassociated AD patients). Based on CIP patient's cohort (n = 21), the mean NRSI at baseline was 8.33 AE 0.80 and the NRSI final was 0.95 AE 0.59. The mean time to first improvement was 2 AE 0 weeks, while the time to complete improvement (Time-final) was 14.6 AE 10 weeks. At the end of treatment, 3 patients out of 21 (14%) had a complete remission of pruritus and 100% of patients had a reduction of NRSI >4. No serious treatment-emergent adverse events were reported. The most common adverse event was mild conjunctivitis (13 c...

Dupilumab for Chronic Prurigo: Case Series on Effectiveness, Safety, and Quality of Life

“…Side effects were reported by 40% but were mild. This favorable safety profile is also reported in current literature, with conjunctivitis and keratitis being common side effects [23]. Those side effects were not reported in this study, possibly due to small sample size.…”

“…Side effects are generally mild and include local reaction at the injection site, conjunctivitis, upper respiratory tract infection, headache, and oral herpes [12]. The effectiveness of dupilumab in patients with CPG has previously been reported showing beneficial effects on both skin manifestations and QoL [13][14][15][16][17][18][19][20][21][22][23].…”

Evaluation, management and future perspectives of anal pruritus: a narrative review

“…One of the first to get the FDA approval was dupilumab, which occupies IL-4 receptor α, thus blocking the effects of IL-4 and IL-13 [ 48 ]. It showed a broad spectrum of anti-itch action as it significantly alleviated chronic itch for patients with atopic dermatitis, chronic prurigo nodularis [ 49 – 51 ]. Furthermore, as the systematic review by Gael et al show, the use of dupilumab can help 14% of patients with chronic idiopathic itch achieve full resolution and up to 89% can reach marked improvement.…”

Chronic prurigo

“…A recent systematic review on 25 retrospective articles counting a total of 153 patients showed promising results. 75 A recent database study on current clinical trials [clinicaltrials.gov, European Clinical Trials Database (EudraCT), US clinical trial registry ICH-GCP] showed that new therapies, including biologics (e.g. nemolizumab, dupilumab, tralokinumab, lebrikizumab and vixarelimab), small molecules (e.g.…”

“…Randomized clinical trials are ongoing. A recent systematic review on 25 retrospective articles counting a total of 153 patients showed promising results 75 …”