Dupilumab: an Additional Arrow in the Quiver for Prurigo Nodularis? Data From a Real-Life Setting

Prurigo nodularis (PN) management remains a significant challenge due to its chronicity, treatment resistance, and scarcity of approved treatments and to its impact on patients' quality of life.

The aim of this study was to assess PN therapeutic management in a real-life setting.

In this prospective observational study, 90 patients diagnosed with moderate-to-severe PN were included. Patients were each prescribed therapies available for PN according to symptom severity, consistent with treatment guidelines; only those undergoing systemic therapies were included. Disease severity was evaluated through the measurements of Investigator's Global Assessment (IGA) score, Numeric Rating Scale (NRS) for pruritus, and Dermatology Life Quality Index (DLQI) at the beginning of the study (week 0 - W0 ) and after a 6-month period of treatment (W24).

At W0, patients were prescribed antidepressants (41.0%), dupilumab (34.0%), antihistamines (23.0%), phototherapy (4.0%) or nemolizumab (2.0%). At W24, patients on dupilumab achieved an IGA score of 0 or 1 and a ≥4-point NRS reduction, more than those on antidepressants (44.5% vs 16.7% and 54.4% vs 16.7%, respectively). The average DLQI score was reduced by 14 points in the dupilumab group, compared to a 6-point reduction in the antidepressant group.

Our findings reflect the real-world practice of treating PN and support the use of dupilumab as a new effective treatment option, with significant improvements in pruritus, quality of life, and disease severity compared to antidepressant therapy, suggesting its potential as a preferred therapeutic option for PN.