It is postulated that interleukin-31 may play a role in the pathobiologic mechanism of atopic dermatitis and pruritus. Nemolizumab, a humanised antibody against interleukin-31 receptor A has been evaluated in the treatment of this condition.
A commentary notes the recent results of two placebo-controlled, phase 3 trials of subcutaneous dupilumab, a human monoclonal antibody against interleukin-4 receptor alpha that inhibits signaling of the crucial type 2 cytokines, interleukins 4 and 13. Significant improvement was seen in the primary outcome as well as in all secondary efficacy and patient-reported outcomes, including pruritus, sleep disturbance, quality of life, and symptoms of anxiety or depression.
It adds that even with these excellent results from this and other studies, some of the patients in the treatment groups did not have improvement in their symptoms. It suggests that perhaps another immunologic mechanism may be prominent in their disease and that for certain ethnic groups and ages, these immunologic responses may be important in disease persistence. It notes that currently, atopic dermatitis is approached as one disease, even though the condition has many clinical phenotypes, therefore the development of biomarkers for different phenotypes of atopic dermatitis will be important in determining the most effective treatments. The commentator calls for larger long-term studies and paediatric trials to fully understand how this and other new agents will fit into the management of atopic dermatitis and to evaluate how quickly patients have disease flares after stopping the agents and whether the addition of topical agents may provide more effective or longer remission.