A critical evaluation of nemolizumab for prurigo nodularis

ABSTRACT

Introduction

Prurigo nodularis (PN) is a chronic inflammatory skin condition that presents with intensely pruritic, hyperkeratotic nodules. The pathophysiology underlying PN is not entirely clear, making treatment challenging. Patients often require a multimodal approach, although many of the available therapies have low efficacy or adverse effects.

Areas covered

In this review, we discuss the use of nemolizumab for the treatment of PN in adults. Nemolizumab is a biological therapy that reduces type 2 cytokines and the neuroimmune response implicated in the pathophysiology of PN. It also helps maintain skin barrier integrity, which may be damaged during the vicious itch-scratch cycle. Nemolizumab has demonstrated great efficacy in improving itch and clearing lesions in recent clinical trials with respectable tolerance.

Expert opinion

Nemolizumab is a promising drug for PN that seems comparable to the recently approved dupilumab in terms of its therapeutic effect and excellent safety profile, although nemolizumab may work more rapidly on itch. JAK inhibitors are also emerging as competitors of biologics for PN, however, their safety profile in this population may differ. Trials evaluating these drugs are needed to assess which is preferable. Additional data on the durability and longevity of nemolizumab for PN treatment is highly anticipated.

KEYWORDS:

• IL-31
• itch
• nemolizumab
• prurigo nodularis
• pruritus
• type 2 cytokines

Article highlights

• Prurigo nodularis (PN) is an intensely pruritic chronic skin condition that can have a drastic impact on quality of life.

• Dupilumab was recently approved in the United States for the treatment of PN in adults. Other current therapies are minimally effective and have adverse effects.

• Nemolizumab is a biologic that reduces type 2 cytokines implicated in the pathophysiology of PN.

• Nemolizumab has demonstrated efficacy in reducing itch and the number of lesions in recent phase III clinical trials.

• Additional data is needed to assess the durability and longevity of the effect of nemolizumab on PN once treatment is stopped.

• There are some potential advantages of nemolizumab over dupilumab, including its rapid onset of effect. Further research is necessary to compare these two drugs in PN patients.

Declaration of interests

G Yosipovitch; Funding/Grants: Sanofi, Regeneron Pharmaceuticals Inc., Pfizer, Escient Health, Novartis, Eli Lilly, Celldex, and Kiniksa Pharmaceuticals. Consulting support: Abbive, Arcutis, Escient Health, Eli Lilly, Galderma, LEO Pharma, Novartis, Pfizer, Pierre Fabre, Regeneron Pharmaceuticals Inc., Sanofi, Trevi Therapeutics, Vifor, Kamari, and Kiniksa. Patents: Topical Acetaminophen Formulations for Itch Relief. Honoraria: Maruho. Participation on a Data Safety Monitoring or Advisory Board: AbbVie, Escient Health, Eli Lilly, Galderma, LEO Pharma, Novartis, Pfizer, Pierre Fabre, Regeneron Pharmaceuticals Inc., Sanofi, Trevi Therapeutics, Vifor, Kamari, and GSK. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

One reviewer has cooperations with diverse companies including Sanofi, Galderma, Lilly and Leo. The remaining reviewers have no other relevant financial relationships or otherwise to disclose.

Information resources

For general information on PN, please visit https://www.aad.org. For the most up-to-date clinical trials that are underway for the use of Nemolizumab for the treatment of PN, please visit clinicaltrials.gov and use the search terms ‘nemolizumab’ and ‘prurigo nodularis.’

Additional information

Funding

This paper was not funded.