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Hope for relief in atopic dermatitis

Published online: August 23, 2019

Atopic dermatitis is associated with skin inflammation and itch. For many patients with atopic dermatitis, itch can be severe and disabling, causing problems with sleeping, at home, school and work. Many patients with atopic dermatitis have a hard time coping with skin lesions and itch despite existing treatments.

In an article recently published in The Journal of Allergy & Clinical Immunology (JACI), Silverberg and co-authors evaluated the use of nemolizumab, a novel therapeutic agent that blocks the signaling of the IL-31 molecule, which has been shown to be key in the development of itch and skin inflammatory lesions in atopic dermatitis. Over the course of 6 months, these researchers compared treatment with nemolizumab (10, 30, or 90 mg doses) or placebo in adults with moderate-to-severe atopic dermatitis and severe itch who had not responded well to other treatments. Participants in the study also used topical corticosteroids similar to real-world use of systemic and biologic treatment in atopic dermatitis. The effects of treatment were measured by the eczema area and severity index, itch numerical rating score, and the physician’s overall assessment, etc.

The authors found that nemolizumab improved atopic dermatitis severity as shown by markedly lower scores for the eczema area and severity index by week 8 and physician’s global assessment by week 4. Thirty-three percent (33%) of patients who received nemolizumab had clear or almost clear skin by week 16, compared with 12% in the placebo group. Itch as measured by peak pruritus numerical rating score was dramatically reduced within one week in those who took nemolizumab, and remained markedly improved throughout the study period with a peak reduction of 69% (for comparison, itch was improved by 35% in the placebo group).

Best improvement of atopic dermatitis was observed with the 30 mg nemolizumab dose. Silverberg et al concluded that “nemolizumab resulted in rapid and sustained improvement” of atopic dermatitis and itch, with an acceptable safety profile.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.