Dupilumab improves clinical manifestations, symptoms and quality of life in adult patients with chronic nodular prurigo

BACKGROUND: Chronic nodular prurigo (CNPG) is a multifactorial skin disease characterized by itchy papules and nodules, usually resistant to standard treatment and associated to markedly impaired quality of life. OBJECTIVE: To describe dupilumab effectiveness and tolerability in treating adult patients with CNPG refractory to both topical and systemic therapies. METHODS: Retrospective, multicenter study including adult patients affected by CNPG, who were treated with dupilumab for at least 16 weeks. RESULTS: Twenty-seven CNPG patients showed clinical improvement in terms of skin lesions, itch, sleeplessness, and quality of life. A consistent proportion (24/27, 88.9%) of patients had at least 16-week continuous treatment and achieved IGA 1 (11/24, 45.8%). An increased number of patients achieving at least 2-grade reduction in IGA score (19/24, 79.2%). Itch-Numeric Rating Scale (NRS) and sleeplessness-NRS values dropped from 8.9 to 2.7 and from 8.2 to 1.7, respectively (p values < 0.001), after 16-week therapy. Ten patients achieved 36 weeks of continuous treatment maintaining clinical efficacy. LIMITATIONS: Major limitations include: lack of validated assessment tools at the time of initial data collection, limited cohort of treated patients, and short term observation period. CONCLUSION: Dupilumab was proven effective in reducing itch and improving CPNG skin lesions.