Prurigo nodularis

Huang, Amy; Williams, Kyle; Kwatra, Shawn G.

doi:10.1016/j.jaad.2020.04.183

Cited by 97 publications

(68 citation statements)

References 49 publications

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“…1,2 CP is often associated with an underlying condition and is frequently multifactorial. 3,4 Nevertheless, there is no evidence that the initial underlying aetiology has an influence on the clinics, severity or course of CP supported by its autonomous persistence after treating the underlying cause.…”

Section: Introductionmentioning

confidence: 99%

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

Gael

Adam²,

Bursztejn

2022

Acad Dermatol Venereol

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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...

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Section: Introductionmentioning

confidence: 99%

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

Gael

Adam²,

Bursztejn

2022

Acad Dermatol Venereol

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“…At the time of our patient admission, the clinical indication for dupilumab is clinically approved for the treatment of atopic dermatitis. Therefore, the use of dupilumab is off-label for this patient [7] . On September 28, 2022, the U.S. Food and Drug Administration officially approved dupilumab for clinical use in the treatment of PN.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

“…PN is one of the most pruritic diseases associated with pruritus in dermatology [2,18] . Clinical statistics found that the pruritus VAS score of PN can reach to maximum 10 points [7,19,20] . Therefore, it is very important to effectively control and treat the pruritus caused by PN.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Dupilumab for Recurrent Prurigo Nodularis: A Case Report and Review of the Literature

2023

medsc

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Prurigo nodularis (PN) is a chronic inflammatory skin disease that affects the quality of life of patients and is classified in the ICD-10 as a group of chronic lichen simplex and itchy skin diseases (ICD-10/L28) with an incidence of approximately 36.7-148.53 per 100,000 people. The pathogenesis of PN is closely related to type 2 inflammatory response. There are no standardized treatment guidelines for this disease, and traditional anti-pruritic treatment regimens often fail to control the vicious pruritic-scratch cycle in PN and have a poor safety profile. Traditional treatment options for PN include oral antihistamines, thalidomide, and topical hormones, calcium phosphatase inhibitors, and other treatments. However, traditional treatment options often suffer from poor pruritus control and high side effects. A patient with prurigo nodularis was admitted to our hospital who responded poorly to routine topical glucocorticoids and other drug therapies and relapsed after discharge from treatment. After readmission, the patient was successfully treated with dupilumab, a biological agent targeting interleukin-4/13. The patient's rash was significantly flattened, and the pruritus NRS score was significantly decreased. In this case, successful treatment of refractory PN with dupilumab could provide new ideas for treatment.

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“…Prurigo nodularis (PN) is a chronic infammatory skin disease with symmetrical distribution of nodules as typical skin lesions and severe itching as the main symptom [1]. Te lesions are typically located in symmetric linear arrangements along the extensor surface, the face and palms are rarely involved, and nodules do not occur in the sites that are not reached by the patient [2]. Histopathological examination of the skin of PN lesions shows a dense infltration of eosinophils, T lymphocytes, and mast cells that release multiple proinfammatory cytokines [3]; however, the incidence and prevalence of PN are not very clear, but some surveys show that it occurs more frequently in women and the elderly [2] and can also occur in children [4].…”

Section: Introductionmentioning

confidence: 99%

Dupilumab Therapy of Prurigo Nodularis: A Single‐Center, Real‐Life Observational Study

Jing

Yang

Liu

et al. 2023

Dermatologic Therapy

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Prurigo nodularis (PN) is a chronic inflammatory skin disease characterized by severe itching accompanied by multiple nodules throughout the body. There is currently no effective drug-targeted treatment for PN. Dupilumab is a fully human monoclonal antibody which can suppress the Th2 inflammatory reaction. We aimed to assess the efficacy and safety of dupilumab in PN. There were 29 PN patients who received dupilumab treatment for four months. Serum total immunoglobulin E (Ig E), eosinophil counts, dermatology life quality index (DLQI), and numeric rating scale (NRS) were assessed on patients before and after treatment. We count the vaccination of novel coronavirus pneumonia (COVID-19) in patients and the impact on PN and treatment measures after vaccination. Plotting was performed using GraphPad Prism8, and the statistical analysis was performed using PASW Statistics18. The eosinophil counts in patients higher decreased to normal, and the Ig E levels gradually decreased and tended to normal levels after receiving dupilumab injection. The average DLQI score at the baseline was 23.93 ± 0.66 and decreased to 11.66 ± 0.55 ( P < 0.01 ) and 1.83 ± 0.22 ( P < 0.01 ) at 1-month and 6-monthfollow-up of treatment, respectively. The average NRS score at the baseline was 9.79 ± 0.08 and decreased to 3.52 ± 0.23 ( P < 0.01 ) and 0.31 ± 0.15 ( P < 0.01 ) at the 1-month and 6-monthfollow-up of treatment, respectively. Our study shows that dupilumab has achieved good efficacy in PN with few adverse reactions and high safety. We can recommend that patients follow the advice of specialists to be vaccinated and under the condition of stable disease, separated from dupilumab treatment for one week.

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Prurigo nodularis

Cited by 97 publications

References 49 publications

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

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

Dupilumab for Recurrent Prurigo Nodularis: A Case Report and Review of the Literature

Dupilumab Therapy of Prurigo Nodularis: A Single‐Center, Real‐Life Observational Study

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