Abstract
We report the characteristics and course of 10 cases of highly pruritic atopic dermatitis treated with nemolizumab (anti-interleukin-31 receptor antibody) in our hospital. The cohort comprised nine men and one woman, with age, eczema area and severity index (EASI), and pruritus numerical rating scale (pNRS) score ranging from 24–76 years (mean: 54.3 years), 0.6–24.6 (mean: 15.3), and 5–10 (mean: 6.8), respectively. Half the patients had previously used biologics or Janus kinase (JAK) inhibitors, of which four had used dupilumab. Three patients discontinued nemolizumab during the treatment course.
The EASI improved gradually, but the pNRS scores of all patients decreased after the first dose; six of the seven continuing patients achieved a pNRS score of 0–1 by 24 weeks. Immunoglobulin E (IgE) levels mostly remained unchanged. The levels of thymus and activation–regulated chemokine (TARC) stably decreased in two patients, but repeatedly increased and decreased in the others. Three of the four patients previously using dupilumab achieved a pNRS score of 0 after the first dose, while the remaining patient achieved a pNRS score of 0 after the second dose. Symptoms of itching improved earlier in patients previously using dupilumab. Among the seven types of biologics and JAK inhibitors available, nemolizumab was more effective in patients with severe itching whose skin symptoms could be moderately controlled with topical steroids. The clinical assessment tools EASI and pNRS score can be considered more insightful measures of treatment efficacy than IgE and TARC levels.
