TOPLINE

Dupilumab demonstrated efficacy and safety over 52 weeks in adults with difficult-to-treat prurigo nodularis (PN) in a study that included many patients who would have been excluded from phase 3 clinical trials.

METHODOLOGY

• Researchers enrolled 69 patients (mean age, 60.6 years; 56.5% women; 76.8% White) with PN who initiated dupilumab in the BioDay registry in Netherlands between February 2023 and February 2025.
• A total of 49.3% of participants would have been ineligible for the phase 3 trial because of comorbidities, concomitant systemic medication, atopic dermatitis, prior biologic use, hepatitis B, or cognitive impairment.
• Patient-reported outcomes included peak pruritus numeric rating scale (PP-NRS), Dermatology Quality-of-Life Index (DLQI), NRS sleep deprivation, and NRS skin pain.
• At baseline, the mean PN duration was 12.6 years, mean PP-NRS was 8.2, and 47.8% had a history of receiving at least two systemic therapies.

TAKEAWAY

• At week 52, 64.1% of patients had achieved at least a 4-point reduction in PP-NRS, and 28.9% achieved a PP-NRS ≤ 3, whereas 48.3% achieved Investigator Global Assessment of PN-stage (IGA PN-S) scores of 0/1.
• Estimated probabilities of 90.4% achieved a DLQI score of 5 or less and 79.6% achieved NRS sleep deprivation scores of 3 or less at week 52. Only 16.4% achieved PP-NRS ≤ 3 and IGA PN-S 0/1 at week 52.
• Treatment effectiveness was similar across subgroups defined by atopic comorbidity or atopic dermatitis status, suggesting that interleukin (IL)-4/IL-13 targeting may be beneficial in PN regardless of atopic status.
• Adverse events included infections (21.7%), ocular surface disease (20.3%), and arthralgia/myalgia (14.5%), and seven patients (10.1%) discontinued treatment.

IN PRACTICE

“Dupilumab demonstrated sustained effectiveness and favorable safety in this difficult-to-treat real-world PN cohort,” the authors of the study wrote.

SOURCE

This study was co-led by Lian F. van der Gang, MD, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, Netherlands, and Octavian Bacoş-Cosma, MD, University of Groningen, University Medical Center Groningen, Groningen, Netherlands. It was published online on July 18, 2026, as a short communication in the Journal of the American Academy of Dermatology.

LIMITATIONS

The authors did not list any limitations.

DISCLOSURES

This study was supported by Sanofi-Genzyme/Regeneron. The BioDay registry was sponsored by AbbVie, Eli Lilly and Company, LEO Pharma, Pfizer, and Sanofi-Genzyme/Regeneron. Gang declared being a speaker and/or consultant for AbbVie and Sanofi, with all fees paid in full to the institution. Several others reported having ties with pharmaceutical companies, including consulting, speaking, advisory roles, and research support. Full disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.