Close Up With Gil Yosipovitch, MD

Gil Yosipovitch, MD, Professor and Stiefel Chair of Medical Dermatology and Director of the Miami Itch Center at the University of Miami presented results from two studies on the use of dupilumab in prurigo nodularis at the 2023 European Academy of Dermatology and Venereology (EADV) Congress in Berlin, Germany.

Taken together, the results of these studies highlight a potentially important role that dupilumab can play in prurigo nodularis.

“The data from these two studies show that dupilumab can improve signs and symptoms of prurigo nodularis with or without background therapy,” Dr. Yosipovitch tells Practical Dermatology® magazine.

“As this disease is driven by itch, patient-centric practices are extremely important, and patient satisfaction using dupilumab is very high, even in those patients who did not achieve a multicomponent endpoint of clinically meaningful response on both itch and skin lesions during the study period.”

Why is this topic important to study?

Gil Yosipovitch, MD: Prurigo nodularis is a chronic, debilitating skin disease that has one of the highest impacts on a patient’s quality of life among all inflammatory skin diseases, due to the severe itch it causes, and patients can also experience lack of sleep. It is also considered a relatively rarer disease, though true prevalence numbers are not well known because there is generally low awareness. Dupilumab (Dupixent) is currently approved in several countries around the world for the treatment of prurigo nodularis and was the first and only targeted medicine in the U.S. and the EU specifically indicated for the disease. Dupilumab is a biologic medicine that directly targets two key and central drivers of type 2 inflammation, a type of overactive immune response that occurs in prurigo nodularis. Dupilumab has been shown to reduce key signs and symptoms of disease including in itch and skin lesions. Before dupilumab, treatment for prurigo nodularis was primarily topical corticosteroids which had limited efficacy, followed by oral broad immunosuppressants that had many side effects and were not targeted. By specifically targeting an underlying source of inflammation, dupilumab is a different approach to managing this chronic disease.

What did the studies find?

Dr. Yosipovitch: The study looking at dupilumab treatment in patients with prurigo nodularis who did not achieve the multicomponent endpoint showed that people treated with dupilumab experienced significant improvements in treatment satisfaction compared to placebo, including in patients who did not achieve clinically meaningful improvement in both itch and skin clearance1. Prurigo nodularis can have a substantial impact on quality of life. It is important to understand how medicines impact not only the signs and symptoms of disease but also the patient experience, including satisfaction, while on treatment. In some patients, it may take more time to achieve the multicomponent endpoints, as the scars and nodules take more time to fully heal. These findings were based on a pooled analysis from LIBERTY-PN PRIME and PRIME 2.¹

The study looking at the use of dupilumab in patients with prurigo nodularis regardless of stable use of topical corticosteroids and topical calcineurin inhibitors comprised pooled Results from Two Phase 3 Trials, LIBERTY-PN PRIME, and PRIME2.²

Dupilumab reduced itch and skin lesions and improved health-related quality of life measures in patients with prurigo nodularis, regardless of whether or not they used dupilumab in conjunction with topical treatments.

Dr. Yosipovitch disclosed relationships with Abbvie, Arcutis, Escient Health, Eli Lilly, Galderma, LEO Pharma, Novartis, Pfizer, Pierre Fabre, Regeneron Pharmaceuticals, Sanofi, Vifor, GSK, Kamari, Escient, and Celldex.

1. Yosipovitch G, et al. Dupilumab treatment improves satisfaction in patients with prurigo nodularis who did not achieve the multicomponent endpoint: Analysis from LIBERTY-PN PRIME and PRIME 2. Presented at: European Academy of Dermatology and Venereology (EADV) Congress 2023, Berlin.

2. Yosipovitch G,et al. Dupilumab is efficacious in patients with prurigo nodularis regardless of stable use of topical corticosteroids and topical calcineurin inhibitors: Pooled results from two phase 3 trials (LIBERTY-PN PRIME and PRIME2). Presented at: Presented at European Academy of Dermatology and Venereology (EADV) Congress 2023, Berlin.