NEMOLIZUMAB IN CHRONIC NODULAR PRURIGO
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Abstract
Pruritis for more than 6 weeeks along with scratching and presenxe of multiple pruriginous lesions is defined as Chronic prurigo (CPG)1. According to the clinical phenotype, CPG is classified into five subtypes:2
1. Papular (papules smaller than 1 cm),
2. Plaque (flat plaque > 1 cm)
3. Nodular (equal to prurigo nodularis, nodule > 1 cm)
4. Linear (linear arrangement),
5. Umbilicated (ulcers within the lesions) types.
All these subtypes can co exist together.
CNPG- Chronic Nodular Prurigo is characterized by intensively pruritic hyperkeratotic along with dome-shaped nodules which are more than 1 cm3. Pruritic is often persistent with high intensity of itch severity along with burning, stinging and pain. This can have negative impact on their appearance, daily activities, and quality of sleep 4. Along with this, increased incidence of mental health disorders has been found in some cases.5
ETIOLOGY- Can be heterogenous and multifactorial including dermatological, systemic, neurologic, psychiatric or the combination of the above conditions, and unknown1. Psychiatric diseases, diabetes, atopic eczema, and allergy are most commonly associated diseases with chronic prurigo4. Along with these, co-morbidities such as pulmonary disease, cancer, human insufficiency virus (HIV), and metastatic disease are also associated5,6.
References
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3. Ständer, H.F.; Elmariah, S.; Zeidler, C.; Spellman, M.; Ständer, S. Diagnostic and Treatment Algorithm for Chronic Nodular Prurigo. J. Am. Acad. Dermatol. 2020, 82, 460–468.
4. Pereira, M.p.; Hoffmann, V.; Weisshaar, E.; Wallengren, J.; Halvorsen, J.a.; Garcovich, S.; Misery, L.; Brenaut, E.; Savk, E.; Potekaev, N.; et al. Chronic Nodular Prurigo: Clinical Profile and Burden. A European Cross-Sectional Study. J. Eur. Acad. Dermatol. Venereol. 2020, 34, 2373–2383.
5. Huang, A.H.; Canner, J.K.; Khanna, R.; Kang, S.; Kwatra, S.G. Real-World Prevalence of Prurigo Nodularis and Burden of Associated Diseases. J. Investig. Dermatol. 2020, 140, 480–483.
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7. Wong, L.-S.; Yen, Y.-T. Chronic Nodular Prurigo: An Update on the Pathogenesis and Treatment. Int. J. Mol. Sci. 2022, 23, 12390.
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9. Ständer, S.; Pereira, M.P.; Berger, T.; Zeidler, C.; Augustin, M.; Bobko, S.; Brenaut, E.; Chen, S.C.; Chisolm, S.; Dalgard, F.J.; et al. IFSI-Guideline on Chronic Prurigo Including Prurigo Nodularis. Itch 2020, 5, e42.
10. Silverberg, J.I.; Pinter, A.; Pulka, G.; Poulin, Y.; Bouaziz, J.-D.; Wollenberg, A.; Murrell, D.F.; Alexis, A.; Lindsey, L.; Ahmad, F.; et al. Phase 2B Randomized Study of Nemolizumab in Adults with Moderate-to-Severe Atopic Dermatitis and Severe Pruritus. J. Allergy Clin. Immunol. 2020, 145, 173–182.
11. Tsoi et al ;Transcriptomic characterization of prurigo nodularis and the therapeutic response to nemolizumab ;J Allergy Clin Immunol. 2022 April ; 149(4): 1329–1339.
12. Kabashima K, Matsumura T, Komazaki H, Kawashima M; Nemolizumab-JP01 Study Group. Trial of Nemolizumab and Topical Agents for Atopic Dermatitis with Pruritus. N Engl J Med. 2020 Jul 9;383(2):141-150.
13. Ständer S, Yosipovitch G, Lacour JP, Legat FJ, Paul C, Reich A, Chaouche K, Ahmad F, Piketty C. Nemolizumab efficacy in prurigo nodularis: onset of action on itch and sleep disturbances. J Eur Acad Dermatol Venereol. 2022 Oct;36(10):1820-1825.
14. Ständer, S.; Yosipovitch, G.; Legat, F.J.; Lacour, J.-P.; Paul, C.; Narbutt, J.; Bieber, T.; Misery, L.; Wollenberg, A.; Reich, A.; et al. Trial of Nemolizumab in Moderate-to-Severe Prurigo Nodularis. N. Engl. J. Med. 2020, 382, 706–716.
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Dr. Shaktibala Dutta
Professor and HOD, Department of Pharmacology, Graphic Era Medical college, Graphic Era Deemed University, Dehradun
Dr. Navneet Dev
Associate Professor, Department of Dermatology, Graphic Era Medical College, Graphic Era Deemed University, Dehradun
Dr. Jyotsna Sharma
Professor & HOD, G S Medical College Pilkuhua
Dr. Smriti
Senior Resident, Department of Pharmacology, Graphic Era Medical college, Graphic Era Deemed University, Dehradun
Dr. Manjeeta Gupta
Senior Resident, Department of Pharmacology, Graphic Era Medical college, Graphic Era Deemed University, Dehradun
Dr. Deo Narayan Chaudhary
Assistant Professor, Department of Pharmacology, Graphic Era Medical college, Graphic Era Deemed University Dehradun
Dr. Amit Singhal
Associate Professor Department of Pharmacology, Graphic Era Medical college, Graphic Era Deemed University, Dehradun
Dr.Srihari Dutta
Regional Health Specialist, PHC, UNICEF, MENARO
Amit Kumar
Assistant Professor, Department of Pharmacology, Government Medical College, Badaun9