Department of Dermatology and Venereology, Hospital de Baza, Granada, Spain.
Hamad Medical Corporation, Translational Research Institute, Doha, Qatar.
J Dermatolog Treat. 2022 May;33(3):1547-1553. doi: 10.1080/09546634.2020.1853024. Epub 2020 Dec 3.
Dupilumab has been shown effective for prurigo nodularis (PN). However, precise data about efficacy of dupilumab as off-label use in PN is missing. We aggregated current evidence to assess efficacy of dupilumab in PN and to identify possible response predictors.
Five electronic databases were searched. Our primary outcome was improvement in pruritus measured by numerical rating scale (NRS). We collected data on NRS before (NRSpre) and after (NRSpost) the dupilumab therapy and designed two categorical variables: 'NRS_50' and 'NRS_100' defined as whether one patient reaches 50% and 100% reduction of the NRSpre. Secondary outcomes included: time until patient perceived any improvement (Time_First) and time until patient reported absence of pruritus (Time_Final).
Data on 45 patients from eleven articles were analyzed. The NRSpre was 8.58 ± 1.89 and the NRSpost was 1.78 ± 2.29. Time_First was 10.15 ± 10.56 weeks, while Time_Final was 19.28 ± 13.71 weeks. 22/45 patients (48.88%) presented with complete resolution (NRS_100) and 37/45 patients (82.22%) had itch half dropped (NRS_50). Time_First was significantly longer in subjects that did not reach NRS_100 (13.13 ± 13.77) than in subjects that did (7.34 ± 7.86, = .05). Time_First was significantly longer in atopic dermatitis (AD) patients (16.08 ± 16.18) than in subjects without AD (7.02 ± 5.69, =.01). NRS_50 and NRS_100 presented with a significant association (=.05).
Dupilumab is an effective target-to-treat agent. In comparison with AD, the clinical response to dupilumab initiates later and, two months of therapy are required until significant itch relieves. Complete remission is rarely observed before 4 months of therapy. Notably, AD-related PN patients need longer treatment than non-AD related PN patients to find any relief. Two early signs of improvement are promising predictors of response to dupilumab: The Time_First and NRS_50. Dupilumab has been shown to be an efficacious treatment for prurigo nodularis (PN)However, literature data on this topic are scattered. This work presents the largest cohort of PN patients treated with dupilumab.Our findings demonstrate dupilumab is a novel and effective choiceIn comparison with atopic dermatitis, the clinical response to dupilumab initiates later.Two months of therapy are required until the itch relieves. Complete remission is rarely observed before 4 months of therapy.Atopic dermatitis-related PN patients need more weeks of treatment than non-atopic dermatitis-related PN patients.
度普利尤单抗已被证明对结节性痒疹（PN）有效。然而，关于度普利尤单抗在 PN 中的非适应证使用的精确疗效数据尚不清楚。我们汇总了现有证据，以评估度普利尤单抗在 PN 中的疗效，并确定可能的反应预测因子。
检索了五个电子数据库。我们的主要结局是用数字评分量表（NRS）衡量瘙痒的改善情况。我们收集了度普利尤单抗治疗前后（NRSpre 和 NRSpost）的 NRS 数据，并设计了两个分类变量：“NRS_50”和“NRS_100”，定义为患者的 NRSpre 是否达到 50%和 100%的降幅。次要结局包括：患者开始感觉到任何改善的时间（Time_First）和患者报告无瘙痒的时间（Time_Final）。
从 11 篇文章中分析了 45 名患者的数据。NRSpre 为 8.58±1.89，NRSpost 为 1.78±2.29。Time_First 为 10.15±10.56 周，而 Time_Final 为 19.28±13.71 周。22/45 名患者（48.88%）完全缓解（NRS_100），37/45 名患者（82.22%）瘙痒减半（NRS_50）。未达到 NRS_100 的患者的 Time_First 明显长于达到 NRS_100 的患者（13.13±13.77 比 7.34±7.86，=.05）。特应性皮炎（AD）患者的 Time_First 明显长于非 AD 患者（16.08±16.18 比 7.02±5.69，=.01）。NRS_50 和 NRS_100 呈显著相关性（=.05）。
度普利尤单抗是一种有效的靶向治疗药物。与 AD 相比，对度普利尤单抗的临床反应启动较晚，需要 2 个月的治疗才能显著缓解瘙痒。在治疗 4 个月前很少能观察到完全缓解。值得注意的是，与非 AD 相关的 PN 患者相比，AD 相关的 PN 患者需要更长的治疗时间才能缓解瘙痒。两个早期改善迹象是对度普利尤单抗反应的有希望的预测因子：Time_First 和 NRS_50。
