Successful treatment of prurigo nodularis by dupilumab: Report of 24 patients

Background: Prurigo nodularis (PN) is a chronic pruritic skin disease which is difficult to treat. Current treatment options often lead to limited clinical benefit or severe side effects.Objective: To evaluate the efficacy and safety of dupilumab in the treatment of prurigo nodularis in adults. Method: This study is a retrospective cohort study. Twenty-four adult patients with prurigo nodularis were included and treated with dupilumab. The primary outcomes were the mean reduction in the Investigator's Global Assessment (IGA) score, and pruritus numeric rating scale (p-NRS) score. Outcomes were assessed at baseline, week 4, week16, and week 36.Results: The study included 24 patients, while 9 (37.5%) were male, and the mean(SD) age of the enrolled patients was 49.88 +/- 16.71 years. At the end of treatment, the mean p-NRS score decreased from 7.50 +/- 2.21 to 1.41 +/- 0.91 (P<0.001), sleeplessness numeric rating scale (s-NRS) score declined from 5.33 +/- 3.29 to 0.18 +/- 0.59(P <0.001), and Dermatology Life Quality Index (DLQI) score decreased from 13.32 +/- 4.88 to 0.91 +/- 0.81 (P<0.001). Fourteen (63.6%) patients achieved IGA 0/1 and 21 (95.4%) patients achieved IGA activity 0/1. Among 14 patients who achieved IGA 0/1,10 had an elevated serum IgE level, and patients with a high serum IgE level showed a more remarkable reduction in IGA (r=0.52, P=0.03). Patients with AD responded faster than those without AD (3.76 +/- 1.71 weeks vs 6.40 +/- 1.67 weeks, P=0.01). Adverse events were recorded in 4/24 (16.6%) patients, with conjunctivitis the most frequent.Conclusion: This study demonstrated that dupilumab is effective and safe for prurigo nodularis and could be a potential therapeutic option.