Nemolizumab Rapidly Improves Itch and Sleep in Atopic Dermatitis and Prurigo Nodularis: Study

A new study published in the Journal of the European Academy of Dermatology and Venerology showed that nemolizumab, an interleukin-31 pathway inhibitor, offers individuals with moderate-to-severe atopic dermatitis (AD) and prurigo nodularis (PN) quick relief from itching and sleep difficulties.
The most bothersome symptom of prurigo nodularis and atopic dermatitis is itching, which is linked to severe psychological anguish, sleep loss, and a worse quality of life. It is anticipated that symptomatology and disease burden would be reduced if itching is quickly controlled. A post hoc analysis of 4 pivotal randomized controlled clinical trials of nemolizumab in AD and PN was conducted to further assess the improvement of itch over the first 14 days of therapy because nemolizumab, which targets the interleukin 31 (IL-31) pathway, quickly reduced itch in Phase 2 trials.
Analysis was done using data from OLYMPIA 1 and 2 in PN (N = 560) and ARCADIA 1 and 2 in AD (N = 1728). The patients experienced everyday sleep disturbances and severe itching. Nemolizumab and placebo groups were compared for differences in the percentage of itch and sleep responders (patients with ≥4-point improvement from baseline in peak pruritus numerical rating scale [PP-NRS] or sleep disturbance [SD-NRS] score).
Nemolizumab quickly decreased itch in AD (ARCADIA 1 and 2), and by Day 2 (pooled data: 10.7% vs. 2.9%; 95% CI: 5.6–10.1; p < 0.0001), there was a difference with placebo in PP-NRS responders that continued to grow until Day 14. Nemolizumab also quickly decreased itching in PN (OLYMPIA 1 and 2); on Day 2, there was a difference with placebo (pooled data: 17.2% vs. 3.7%; 95% CI: 6.8–16.7; p<0.0001).The patients receiving nemolizumab also showed early improvement in their sleep (Day 2). In pooled analyses, SD-NRS responders were 9.9% (nemolizumab) against 4.6% (placebo; 95% CI: 2.8–7.7; p = 0.0001) in AD and 13.4% versus 4.3% (95% CI: 4.0–13.0; p = 0.0013) in PN. Individual study results on itching and sleep response matched the pooled data.Overall, nemolizumab had a quick beginning of effect in reducing itching (by Day 2) and enhancing sleep in patients with moderate-to-severe AD and PN, according to the results of this post hoc investigation. Source:Ständer, S., Elmariah, S. B., Kwatra, S. G., Yosipovitch, G., Pink, A. E., Cheong, S. Y., Chen, X., Jabbar-Lopez, Z. K., Ulianov, L., Piketty, C., & Silverberg, J. I. (2025). Rapid improvement of itch with nemolizumab in atopic dermatitis and prurigo nodularis phase 3 studies. Journal of the European Academy of Dermatology and Venereology, jdv.70250. https://doi.org/10.1111/jdv.70250