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Targeting Chronic Itching: Dupilumab for Prurigo Nodularis Patients

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Clinical trial finds that dupilumab relieves itching in patients with prurigo nodularis

Prurigo nodularis (PN) is a chronic skin condition characterized by itchy nodules or lumps. These nodules can be firm and raised, causing intense itching. The cause of prurigo nodularis is not fully understood, but it often develops due to repetitive scratching or other skin irritations. The constant itching and scratching can lead to the formation of these nodules, which can become a cycle that is difficult to break. Treatment may involve medications to reduce itching and inflammation and manage underlying conditions. However, managing prurigo nodularis can be challenging, and seeking medical advice for proper care is essential.

PN can be distressing and severely impact a person's quality of life. The constant itching can be unbearable, affecting sleep, daily activities, and overall well-being. The itching and discomfort can become a vicious cycle, as scratching temporarily relieves the condition by causing more nodules to form.

Clinical Trials

The LIBERTY-PN PRIME and PRIME2 trials investigated a potential treatment for prurigo nodularis, specifically for adults with at least 20 nodules and severe itch that was uncontrolled with topical therapies. The trials tested the efficacy of dupilumab, a human monoclonal antibody that blocks the shared receptor component for interleukin (IL)-4 and IL-13. These cytokines play a crucial role in the inflammatory response, and targeting them with dupilumab could alleviate the symptoms of PN.

In the trials, patients were randomly assigned to receive either 300 mg of dupilumab or placebo subcutaneously every two weeks for 24 weeks. The primary endpoint of the study was the improvement in pruritus (itching) measured by the proportion of patients with a ≥4-point reduction in the Worst Itch Numeric Rating Scale (WI-NRS) from baseline at week 24 in PRIME and week 12 in PRIME2. The secondary endpoint was the reduction in the number of nodules to ≤5 at week 24.

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Findings

The results of both trials were promising. Dupilumab showed clinically meaningful and statistically significant improvements in itch and skin lesions compared to the placebo in patients with prurigo nodularis. In PRIME, 60.0% of patients in the dupilumab group achieved a ≥4-point reduction in WI-NRS at week 24, compared to only 18.4% in the placebo group. Similarly, in PRIME2, 37.2% of patients in the dupilumab group achieved the same reduction at week 12, while only 22.0% in the placebo group did.

The safety profile of dupilumab was consistent with previous knowledge, indicating that it was generally well-tolerated by patients.

Conclusion

Dupilumab may be a promising treatment option for prurigo nodularis, providing much-needed relief from the intense itching and improving the overall condition of affected individuals. However, further research and more extensive studies are needed to confirm the efficacy and safety of dupilumab for PN treatment before it can be widely adopted as a standard therapy. The trials' findings offer hope for those suffering from prurigo nodularis and may pave the way for new treatment strategies to alleviate the burden of this debilitating skin condition.
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Nature Medicine, May-23
clinicaltrials.gov NCT04183335, NCT04202679



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This content is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of such advice or treatment from a personal physician. All readers/viewers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions. CenTrial Data Ltd. does not take responsibility for possible health consequences of any person or persons reading or following the information in this educational content. Treatments and clinical trials mentioned may not be appropriate or available for all trial participants. Outcomes from treatments and clinical trials may vary from person to person. Consult with your doctor as to whether a clinical trial is a suitable option for your condition. Assistance from generative AI tools may have been used in writing this article.