Meta-analysis supports use of dupilumab in first-line treatment of prurigo nodularis

In patients with prurigo nodularis, treatment with dupilumab provides consistent, meaningful improvements in pruritus while having a favourable safety profile, according to a meta-analysis.

Researchers searched multiple online databases for studies in which prurigo nodularis treatments were assessed. Primary outcomes were changes in pruritus and quality of life. Safety was assessed in relation to the incidence of adverse events.

A total of 25 studies met the inclusion criteria and were included in the meta-analysis.

Pooled data showed that treatment with dupilumab was associated with substantial reductions in pruritus (mean difference [MD], −5.76, 95 percent confidence interval [CI], −6.86 to −4.67) and significant improvements in quality of life (MD, −11.84, 95 percent CI, −22.76 to −0.92).

Adverse events occurred in 13 percent of patients (95% CI, 0.02–0.52). Conjunctivitis, dry eyes, and local injection site reactions were the most common.

On the other hand, phototherapy led to complete responses in 23 percent (95 percent CI, 9–48), partial responses in 60 percent (95 percent CI, 39–78), and no response in 7 percent. With thalidomide treatment, the rates of complete, partial, and no response were 15 percent, 49 percent, and 12 percent, respectively.

These findings support the consideration of dupilumab as a first-line systemic treatment option for prurigo nodularis.