Dupilumab for Prurigo Nodularis

People with prurigo nodularis experience persistent itch, with thick skin lesions (called nodules) that can cover most of the body. It is described as painful with burning, stinging, and tingling of the skin. The signs and symptoms of prurigo nodularis can negatively impact health-related quality of life, including mental health, activities of daily living, and social interactions. High-potency topical steroids are commonly used to treat prurigo nodularis, which can cause risks to the body if used long-term.

Dupilumab is a biologic drug that works very differently from other drugs and has significantly reduced itch and skin lesions and improved quality of life.

In the phase 3 trial, dupilumab compared with placebo showed that:

• 37% of Dupilumab patients experienced a reduction in itch from baseline compared to 22% of placebo patients at week 12, the primary endpoint.

• At week 24, nearly three times as many Dupilumab patients experienced a reduction in itch from baseline: 58% of Dupilumab patients compared to 20% of placebo patients.

• At week 24, Dupilumab patients were three times more likely to achieve clear or almost clear skin: 45% of Dupilumab patients compared to 16% of placebo patients.

• Dupilumab patients experienced improvements in skin pain, health-related quality of life, and symptoms of anxiety and depression.

The most common side effects were conjunctivitis, herpes viral infections, and skin infections. 3% of Dupilumab patients and 30% of placebo patients stopped prior to week 24.

The safety and efficacy of dupilumab are still undergoing clinical trials (development) and have not been approved by the FDA.