The effectiveness and safety of dupilumab in the management of refractory prurigo nodularis in 45 Chinese patients: A real-life observational study

Abstract

Prurigo nodularis (PN) is a chronic, pruritic inflammatory skin disease characterized by severe skin itching and hyperkeratotic nodules. The existing treatment options for PN are limited by severe adverse effects. Dupilumab is an approved biological agent for treating atopic dermatitis and other type 2 inflammatory diseases in adults, showing good efficacy and safety in clinical trials. Recently, dupilumab has shown remarkable effects in patients with PN, but the data on Chinese patients are limited. This study aimed to evaluate the safety and efficacy of dupilumab to treat atopic and nonatopic PN in 45 Chinese patients. To our knowledge, this is the largest cohort to date to evaluate the safety and efficacy of dupilumab to treat atopic and nonatopic PN. To achieve this, 45 patients with PN from the department of dermatology of several Grade A hospitals in Shenzhen, China, were treated with off-label prescription dupilumab. We followed-up the patients on weeks 8 and 16, and the pruritus symptoms, changes in lesion color and area, and the quality of sleep and life were evaluated before and after treatment using the Pruritus Peak Numeric Rating Scale (PP-NRS, 0–10), the Dermatology Life Quality Index/Children's Dermatology Life Quality Index (DLQI/CDLQI, 0–30), and the Investigator's Global Assessment Scales for Stage and Activity (IGA/IGAa, 0–4) at weeks 2, 4, 8, 12, and 16. Total serum immunoglobin E and eosinophilic granulocyte levels were the main laboratory indices for patient evaluation. During treatment, the skin lesions and itching symptoms of these 45 patients were relieved remarkably within 2 weeks. All the PP-NRS, DLQI/CDLQI, and IGA/IGAa scores significantly improved from the baseline to 16-week dupilumab treatment (P < 0.001 for all scores) and no adverse events were reported.