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Anti-IL-31 antibody improves pruritus in phase II study.

MONTHLY SUBCUTANEOUS injections of nemolizumab, a humanized antibody that inhibits interleukin-31 signaling, significantly improved pruritus associated with atopic dermatitis (AD) in a small, 3-month phase II trial.

"Although this trial has limitations, most notably the small number of patients and short duration, it provides evidence supporting the role of interleukin-31 in the pathobiologic mechanism of atopic dermatitis," said Thomas Ruzicka, MD, of the department of dermatology and allergology, Ludwig Maximilian University, Munich, and his associates (N Engl J Med 2017;376:826-35).

In the trial, 264 adults in the United States, Europe, and Japan with refractory moderate to severe AD, inadequately controlled with topical treatments, were randomized in a double-blind fashion to receive 12 weeks of 0.1 mg/kg nemolizumab, 0.5 mg/kg nemolizumab, 2.0 mg/ kg nemolizumab, or placebo every 4 weeks. Another 52 participants were given 2.0 mg/kg nemolizumab every 8 weeks in an exploratory analysis. All the study participants were permitted to use emollients and localized treatments, and some were permitted to use a potent topical glucocorticoid as rescue therapy after week 4. A total of 216 patients (82%) completed the trial.

The primary efficacy endpoint was the percentage improvement at week 12 in scores on a pruritus visual analogue scale, which patients recorded electronically every day. These scores improved significantly in a dose-dependent manner for active treatment, compared with placebo. Pruritus declined by 43.7% with the 0.1-mg/kg dose (P =.002), 59.8% with the 0.5mg/kg dose (P less than .001), and 63.1% with the 2.0-mg/kg dose (P less than .001), compared with 20.9% with placebo.

Nemolizumab also bested placebo in several secondary endpoints including scores on a verbal rating of pruritus, the Eczema Area and Severity Index, and the static Investigator's Global Assessment, the investigators said.

The study population was too small to draw conclusions regarding adverse events, but patients who received active treatment had a higher rate of dermatitis exacerbations and peripheral edema than did those who received placebo. The group given 0.5 mg/kg nemolizumab every month showed the greatest treatment benefit and the best benefit-to-risk profile, the authors wrote.

Chugai Pharmaceutical funded the trial. Dr. Ruzicka reported receiving research grants and personal fees from Chugai and honoraria from Astellas; his associates reported ties to numerous industry sources.

dermnews@frontlinemedcom.com

BY MARY ANN MOON

FROM THE NEW ENGLAND JOURNAL OF MEDICINE

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Title Annotation:ATOPIC DERMATITIS
Author:Moon, Mary Ann
Publication:Dermatology News
Date:Jun 1, 2017
Words:403
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