Dupilumab as a treatment for generalized idiopathic pruritus: a report of two cases

Stanger, Roselyn; Rivera-Oyola, Ryan; Lebwohl, Mark

doi:10.1111/bjd.18852

Cited by 7 publications

(4 citation statements)

References 8 publications

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“…Thus, 25 articles were included in the analysis as depicted in the search flow chart (Fig. 1), counting a total of 153 patients 21–45 . Demographic and clinical data of CP patients are summarized in Table 1, and those of CIP patients are summarized in Table 2.…”

Section: Resultsmentioning

confidence: 99%

Efficacy of dupilumab in chronic prurigo and chronic idiopathic pruritus: a systematic review of current evidence and analysis of response predictors

Gael

Adam²,

Bursztejn

2022

Acad Dermatol Venereol

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Dupilumab has demonstrated a great reduction in chronic pruritus that is the hallmark of atopic dermatitis (AD). Underscoring relevant pathogenesis similarities emerging from AD, chronic idiopathic pruritus (CIP) and chronic prurigo (CP), several authors suggested the beneficial role of dupilumab in these conditions. The evidence on this subject is limited with no precise data available. In this study, we carried out a systematic literature review in order to evaluate the efficacy of dupilumab on both pruritus and skin manifestations in the two largest retrospective cohorts of patients with CP and CIP and tried to identify potential response predictors. Electronic searches were conducted on 4 databases. Our primary outcome was the improvement in pruritus measured by a reduction in the patient's reported numerical rating scale of itch (NRSI) by >4. Secondary outcomes included the proportion of patients with a complete response at the end of treatment, reduction in the number of lesions by the Investigator Global Assessment (IGA), improvement in numerical rating scale of sleep (NRSS), improvement in quality of life measured by the Dermatology Life Quality Index (DLQI), time until patient perceived any improvement (Time-First) and time until the patient-reported absence of pruritus (Time-Final). Descriptive statistics were calculated for each demographic and clinical variable. Univariate logistic regression analyses were conducted to explore the association between response to dupilumab and potential predictive factors. We included 25 articles in the analysis, counting a total of 153 patients. Based on CP patients' cohort (n = 132), the mean NRSI at baseline was 8.79 AE 0.86 and the NRSI final was 2.32 AE 1.27. The mean time to first improvement was 5.18 AE 3.13 weeks, while the time to complete improvement of pruritus (Time-final) was 13.6 AE 12.0 weeks. Ninety patients out of 109 (83%) noticed an improvement in pruritus before 4 weeks of dupilumab therapy. At the end of treatment, 18 patients out of 126 (14%) had a complete remission of pruritus and 110 patients out of 123 (89%) had a reduction of NRSI >4. The reduction in NRSI was significantly greater in patients improving before 4 weeks of treatment (6.57 AE 1.71) compared with patients improving in more than 4 weeks (5.49 AE 1.39, P < 0.001). Patients with history of AD and those who have been previously treated with cyclosporine or methotrexate had a significantly lower reduction in NRSI (e.g. 6.05 AE 1.34 vs. 7.08 AE 1.90, P < 0.01 for nonassociated AD patients). Based on CIP patient's cohort (n = 21), the mean NRSI at baseline was 8.33 AE 0.80 and the NRSI final was 0.95 AE 0.59. The mean time to first improvement was 2 AE 0 weeks, while the time to complete improvement (Time-final) was 14.6 AE 10 weeks. At the end of treatment, 3 patients out of 21 (14%) had a complete remission of pruritus and 100% of patients had a reduction of NRSI >4. No serious treatment-emergent adverse events were reported. The most common adverse event was mild conjunctivitis (13 c...

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Section: Resultsmentioning

confidence: 99%

Efficacy of dupilumab in chronic prurigo and chronic idiopathic pruritus: a systematic review of current evidence and analysis of response predictors

Gael

Adam²,

Bursztejn

2022

Acad Dermatol Venereol

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“…Notably, 26 out of 27 reported patients had no AD. In two cases, dupilumab was withdrawn after only 4 weeks and a sustained response was reported for a 20 weeks follow-up period ( Table 2 ) [ 8 , 88 , 89 , 90 ]. Currently, the placebo-controlled RCT LIBERTY-CPUO-CHIC (NCT05263206) is ongoing and recruiting.…”

Section: Resultsmentioning

confidence: 99%

Dupilumab in Inflammatory Skin Diseases: A Systematic Review

et al. 2023

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Dupilumab was first approved for the treatment of atopic dermatitis (AD) and blocks the signaling of interleukin (IL)-4 and -13. Several other chronic skin conditions share mechanistic overlaps with AD in their pathophysiology, i.e., are linked to type 2 inflammation. Most recently, dupilumab was approved by the U.S. Food and Drug Administration for prurigo nodularis (PN). Given its relatively good safety profile, effective off-label use of dupilumab has been reported for a multitude of dermatologic diseases and several clinical trials for dermatologic skin conditions are currently ongoing. We conducted a systematic review of applications of dupilumab in dermatology other than AD and PN by searching the databases PubMed/Medline, Scopus, Web of Science and Cochrane Library as well as the clinical trial registry ClinicalTrials.gov. We found several reports for effective treatment of bullous autoimmune diseases, eczema, prurigo, alopecia areata, chronic spontaneous urticaria, Netherton syndrome and a variety of other chronic inflammatory skin diseases.

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“…22 Another report on dupilumab for the treatment of pruritus of unknown origin also demonstrates that the anti-pruritic effects of dupilumab are not simply a sequelae of the reduction in inflammation. 23…”

Section: Il-4 and Il-13 Blockade Has A Direct Effect On The Neurologi...mentioning

confidence: 99%

Unexpected Clinical Lessons Learned From IL-4 and IL-13 Blockade

Bury,

Zirwas

2023

JDD

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Dupilumab as a treatment for generalized idiopathic pruritus: a report of two cases

Cited by 7 publications

References 8 publications

Efficacy of dupilumab in chronic prurigo and chronic idiopathic pruritus: a systematic review of current evidence and analysis of response predictors

Efficacy of dupilumab in chronic prurigo and chronic idiopathic pruritus: a systematic review of current evidence and analysis of response predictors

Dupilumab in Inflammatory Skin Diseases: A Systematic Review

Unexpected Clinical Lessons Learned From IL-4 and IL-13 Blockade

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