Although the etiology of PN remains diverse and is not fully understood, a substantial proportion of patients with PN have concomitant atopic diseases: 50% AD, 31% asthma, and 71% allergic rhinitis (AR)1. In some patients, several diseases appear simultaneously, with almost 19% of patients with PN displaying the atopic triad (AD, asthma, and AR)1. However, in other patients, PN can exist without the presence of any atopic comorbidities.
While there is evidence that PN is a type 2 inflammatory disease distinct from AD, the efficacy of dupilumab in patients with PN with or without a history of atopic comorbidities has only been investigated recently both in a pre-specified subgroup analysis of the Phase III trials LIBERTY-PN PRIME and PRIME 22, and in long-term real-world evidence studies3.
This article summarizes evidence from this post-hoc analysis and recent real-world evidence studies from a French Early Access Program (EAP) and a long-term Italian retrospective study.

<h2>Key findings</h2>
<ul>
 <li>In randomized clinical trials, dupilumab significantly improved disease signs, symptoms, and health-related quality of life with similar onset time and response magnitude compared with placebo in adult patients with PN, irrespective of the presence or absence of atopic comorbidities2.</li>
 <li>Suppression of aberrant neuro-immune activity through the targeting of type 2 inflammation is suggested to have efficacy in the treatment of PN regardless of atopic background, IgE, or eosinophil levels2.</li>
 <li>In an Italian real-world retrospective study (104 weeks), the comparison between patients with or without concomitant atopic diathesis revealed similar clinical benefits obtained by dupilumab with a significantly more rapid reduction of IGA CPNs score and a significantly higher rate of patients achieving IGA CPNs of 0–1 in patients with concomitant atopic diathesis3.</li>
 <li>Patients that reached the last timepoint (104 weeks) validated some observations of delayed responses up to 1 year, demonstrating that complete resolution of PN may be achievable through long-term treatment3.</li>
 <li>Data from a French early access program (EAP, 12 months), predominantly including patients with non-atopic comorbidities or no comorbidities, shows that dupilumab progressively improves skin lesions and itch intensity over one-year period and demonstrates effectiveness regardless of atopic background4.</li>
 <li>Safety was generally consistent with the known dupilumab safety profile, both in randomized clinical trials and real-world settings2-4.</li>
 <li>These observations suggest that patients with PN may benefit from dupilumab treatment regardless of their atopic history2.</li>
</ul>

Findings from Phase III Randomized Controlled Trials (PRIME/PRIME 2)2

Evidence from Real-Word Studies3-6

Dupilumab significantly improved disease signs, symptoms, and health-related quality of life with similar onset time and response magnitude compared with placebo in adult patients with PN, irrespective of the presence or absence of atopic comorbidities. These benefits were sustained in the long-term, with real-world evidence showing high rates of skin clearance and itch relief through 1 year and beyond. These observations suggest that the suppression of aberrant neuro-immune activity through targeting type 2 inflammation has efficacy in treating PN regardless of atopic background, IgE, or eosinophil levels.

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Efficacy and safety of dupilumab in patients with PN with or without a history of atopic comorbidities

SPECIALTY-CARE

DUPIXENT

PRURIGO-NODULARIS

DERMATOLOGY

I’m sitting together with two widely known experts in dermatology, especially in prurigo, Prof. Sonja Ständer from Münster University Hospital in Germany and Ass. Prof. Jesper Elberling from Herlev and Gentofte Hospital, Copenhagen, in Denmark. They regularly work together in specialist groups discussing chronic prurigo and prurigo nodularis, but today they have promised to discuss this disease with me from its beginning: what is the natural history of chronic prurigo and where does it emerge from? Why do some patients get this chronic disease and others not? And what does this complex condition mean for patients?

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Pea-sized pruritic papules

“The disease is complex but also not complex”

Pruriceptors and nerve fibres are important

Neuro-fibro-inflammatory disease with psychologic problems

Disease that stays

References

Written by Anna Ekman, Medical Lead North Europe at Sanofi

Prurigo nodularis - 
The story of a disease

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Prurigo Nodularis

Voor zorgverleners

Efficacy and safety of dupilumab in patients with PN with or without a history of atopic comorbidities

Prurigo nodularis - The story of a disease