Dupilumab for Chronic Prurigo Induces Remission Among Subset of Patients

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Dupilumab as a treatment for chronic prurigo may be considered safe and effective, a recent study re-established, with major improvements in the disease observed by the 12-week mark.¹

These new findings—authored in part by João Teixeira from the Local Health Unit of Coimbra at the University Hospital in Coimbra, Portugal—were the result of a retrospective unicentric study of adult patients with chronic prurigo given dupilumab in the approved dosage for 12 weeks at least.

The disease of chronic prurigo is characterized by chronic pruritus occurring ≥ 6 weeks as well as localized or generalized pruriginous lesions. Dupilumab was approved for individuals with moderate to severe disease among those eligible for systemic treatments.²

“The objective of this study is to report on a series of (chronic prurigo) patients treated with dupilumab, with a particular focus on three patients who achieved complete disease control that persisted after drug discontinuation, suggesting that dupilumab may break the ‘itch–scratch cycle’ and therefore induce disease remission in a subset of patients,” Teixeira and colleagues wrote.¹

Study Design and Background

The research team first highlighted the fact that chronic prurigo’s underlying mechanisms have not yet been fully comprehended, though the fundamental "itch-scratch cycle" element of the skin disease does provide insight into its persistence. Evidence available to-date points to interleukin (IL)-4 and IL-13 as the critical mediators of pruritus, also known as itch, and the inhibition of these cytokines has been observed with dupilumab.

The efficacy of this therapy was evaluated through the Worst Itch Numeric Rating Scale (WI-NRS), the Investigator Global Assessment (IGA), and the Dermatology Quality of Life Index (DLQI). To look at the medication’s efficacy in treating chronic prurigo, the team’s retrospective review of adult patients who were treated with dupilumab therapy for at least 12 weeks was conducted.

There were 5 male and 5 female participants included in this analysis, with 9 being labeled as Caucasian and all of which having a mean age of 49 years. Among these subjects, 4 years was the median disease duration, 4 subjects also reported diagnoses of atopic dermatitis, and 3 were shown to have confirmatory biopsies.

Results of Dupilumab

Following a median treatment period lasting half a year, the research team concluded that the drug had led to positive findings across all outcomes assessed in their research. Three subjects succeeded in going into complete remission at the 3, 6, and 18-month marks and decided to discontinue treatment.

There had been 1 female and 2 males among those who achieved remission, with a mean age of 45 years and an average disease duration of 9.6 years. Following the follow-up meetings at the 12, 24, and 6-month marks, respectively, the team found that these patients had remained free from lesions and pruritus related to the disease. They did not require any further drugs outside of emollients.

Substantial improvements were reported by the investigators among the remaining 6 participants, given their notably consistent IGA-CPG, WI-NRS, and DLQI score reductions from the point of baseline. Despite these conclusions, there were 2 who the research team found had experienced flares of chronic prurigo during therapy.

A single flare example of these 2 was noted by the team as likely connected to reduction in risperidone, and the other likely resulting from an atopic dermatitis exacerbation. Overall, the team identified no serious side effects, though there was minor conjunctival erythema and allergic rhinitis in a single individual.

The investigators highlighted that the small sample size was a limitation, though they noted that the 33% of subjects who achieved long-lasting, complete disease remission which also persisted after cessation of dupilumab was a significant outcome as it has not been previously reported.

“Information on remission following dupilumab discontinuation is scarce, even in (atopic dermatitis),” they wrote. “A recent study with more than 800 patients showed that less than 10% can stop dupilumab after clearing of (atopic dermatitis), and this seems to occur more frequently in those having concomitant (chronic prurigo), which may be in agreement with our data.”³

References

1. ^{Teixeira J, Soares J, Aparício-Martins A, and Gonçalo M. (2024), Dupilumab may break the “itch-scratch cycle” in chronic prurigo and induce remission in a subset of patients. J Eur Acad Dermatol Venereol. https://doi.org/10.1111/jdv.20277.}
2. ^{Nakajima S, Yonekura S, Nakamizo S, Egawa G, Kabashima K. Dupilumab as a novel treatment option for prurigo nodularis. J Allergy Clin Immunol. 2023; 152(4): 870–872. https://doi.org/10.1016/j.jaci.2023.08.011.}
3. ^{Chiricozzi A, Bello GD, Gori N, Nardo LD, Schena D, Caldarola G, et al. Identification of clinical predictors for dupilumab dose spacing in adults with atopic dermatitis: a real-world study. J Dermatolog Treat. 2023; 34(1):2235041. https://doi.org/10.1080/09546634.2023.2235041.}