Advances in the Management of Prurigo Nodularis - Episode 10

Role of Dupilumab for Treatment of PN

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Raj Chovatiya, MD, PhD; Shawn Kwatra, MD; and Sarina B. Elmariah, MD, PhD, discuss a newly approved drug, dupilumab, for the treatment of PN.

Raj Chovatiya, MD, PhD: If I had to summarize what we’ve talked about here, I’d say that a lot of the challenges that we have now before we had our first approved agent, and hopefully more to come, is that when it comes to topicals, you’re not really treating the whole patient. It’s really hard to get the systemic inflammatory component under control. But when you bump up to systemic agents, oftentimes it’s really hard to couple the neural aspect and the inflammatory aspect together in a way that is targeted, efficacious, and safe, without having other issues coming along.

And that’s a really nice transition to one of the big, exciting things I know that we’ve all talked about before we got on here in terms of dupilumab now being the first FDA [US Food & Drug Association]-approved treatment for prurigo nodularis [PN]. And for those who may not be familiar with dupilumab, this is a monoclonal antibody that targets both the IL-4 [interleukin-4] and IL-13 [interleukin-13] pathways by specifically binding to the IL-4 receptor alpha subunit that is a part of both receptor complexes. And this was approved in September 2022. And so, before we delve into some of the nitty-gritty about the approval, Dr Shawn Kwatra, maybe you can tell us a little bit about the patient population that this might be a therapeutic option for, and what some of the implications are for those patients based on the limitations of previous therapies.

Shawn Kwatra, MD: It’s a great question. Well, first, we’re all very thankful for all of the interest in these patients because even 5 years ago, there was very little interest. And so, we are so excited about this approval for prurigo nodularis patients. If you’re doing a clinical trial, you have to include patients who don’t necessarily have uncontrolled comorbidities, and so one of the things about this patient population is that you’re not going to necessarily have uncontrolled kidney disease, or diabetes and all of that. That’s not to say the drug wouldn’t be effective in that situation, it’s just that it may not be studied. There are also subsets of patients who have neuropathic pruritus, which also manifests as prurigo nodularis, who were not included in the study. But, when you look at the data of the study and the framework in terms of the study population, it was a very well-designed trial. And so, I think you could feel comfortable with the gamut of PN patients trying this therapy.

Transcript edited for clarity