Phase 3 Trial of Nemolizumab in Patients with Prurigo Nodularis
In RCT (n=274), nemolizumab monotherapy reduced signs and symptoms at week 16, with more patients compared to placebo group having an itch response (reduction ≥4 points on PP-N rating scale: 56.3% vs 20.9%; p<0.001) and IGA response (37.7% vs. 11.0%; p<0.001).
Source:
New England Journal of Medicine
SPS commentary:
Prurigo nodularis is a chronic and debilitating neuroimmunologic skin disease characterized by severe itch and multiple nodular lesions that can cover large areas. Interleukin-31 is increased in patients with lesional prurigo nodularis and dermal levels are positively correlated with itch intensity. Nemolizumab, an interleukin-31 receptor alpha antagonist that blocks interleukin-31 signaling, has been reported to improved clinical responses with respect to itch intensity and lesion healing in a phase 2 trial.
An editorial discussed why the blockade of interleukin-31 receptor alpha is so efficient in reducing both itch and fibrotic skin lesions. It notes that more research is needed but suggests the efficacy of nemolizumab in prurigo is probably caused by the blocking of direct effects of interleukin-31 on fibroblasts, which leads to the reduction in fibrotic skin lesions, and on inflammatory cells such as mast cells and eosinophils that can indirectly affect sensory nerves. It concludes that a new era in the management of patients with prurigo has started.