Prurigo Nodularis
Treatment
Systemic therapies
Patients with widespread or recalcitrant PN who fail to respond to phototherapy and those for whom phototherapy is not feasible may benefit from systemic treatments.
Dupilumab
Dupilumab, an interleukin (IL) 4 receptor inhibitor, is effective in reducing pruritus and resolving the skin lesions in patients with recalcitrant PN. Other systemic treatments include systemic immunosuppressants, thalidomide, lenalidomide, and anticonvulsants. These treatments are associated with potential significant toxicity, and their efficacy in patients with recalcitrant PN has not been established.
Dupilumab is a first-line systemic treatment for recalcitrant PN in adults, especially in patients with underlying atopic dermatitis. Dupilumab is administered subcutaneously at an initial dose of 600 mg, followed by 300 mg every other week. Dupilumab was approved by the US Food and Drug Administration for the treatment of PN in adults in September 2022. Multiple reports have documented the efficacy of dupilumab in reducing pruritus and resolving the skin lesions in patients with recalcitrant PN [1]
- In a retrospective study of 19 patients with PN treated with dupilumab, 12 (63 percent) and 13 (68 percent) achieved an Investigator General Assessment (IGA) score of 0/1 (clear/almost clear) at weeks 16 and 52, respectively. Of the 13 patients who achieved an IGA score of 0/1 at week 52, 10 had a concurrent diagnosis of atopic dermatitis.
- In a series of nine adult patients with atopic dermatitis manifesting as generalized PN, dupilumab at the standard dosing regimen (600 mg induction dose followed by 300 mg every two weeks) induced a marked clinical improvement in skin lesions, pruritus, and life quality in all patients.
- In a French, multicentric cohort of 16 adult patients with chronic PN refractory to multimodal treatment regimens, dupilumab induced a complete or partial response of skin lesions and pruritus in 15 patients and no response in 1 patient at three months.
