Journal Digest: October 28

Allergy, Asthma & Immunology Research: Treatment With Upadacitinib in Refractory Prurigo Nodularis: A Prospective Cohort Study 

In a recent study, Lee et alassessed the efficacy and safety of upadacitinib in patients with prurigo nodularis (PN). The selective JAK 1 inhibitor showed rapid relief and toleration, while improving quality of life for patients who had not responded to conventional therapies. The study included 10 patients, aged 18 and older, who were diagnosed with refractory PN between 2021 and 2023. Each patient received 15 mg of upadacitinib each day for 24 weeks. Results were evaluated at baseline, 4, 12, and 24 weeks using the itch Numeric Rating Scale (NRS), Investigator’s Global Assessment of PN (IGA PN), and Dermatology Life Quality Index (DLQI). According to the researchers, all patients tolerated upadacitinib well and did not need any treatment modifications. The mean itch NRS score decreased from 8.1 at baseline to 0.7 by week 24 while the proportion of patients achieving an IGA PN score of 0/1 rose from 0% at baseline to 80% by week 24. The study authors suggest further research that solidifies upadacitinib’s tolerability for PN on a larger scale.¹

The Journal of Dermatology: CurrentClinical Practice of Prurigo Nodularis in Japan: A Cross-Sectional Web-Survey Among Dermatologists

Murota et alestablished the first web-based survey (UMIN000047643) of Japanese dermatologists to observe the clinical management of PN. Between April and June of 2022, 117 dermatologists from hospitals and clinics were surveyed. Each had seen at least one patient with PN in the last three months. Survey questions assessed several attributes including practice setting, treatment details, and perception of patient disease burden. Overall, clinicians consider the number of pruritic nodules and the degree of itching to be the most important aspects when determining if a patient has PN. The most used diagnostic measures were clinical findings and patient interviews while topical corticosteroids and antihistamines were the most used treatment agents. Although most surveyors were very or somewhat satisfied with the outcomes of mild disease treatment, almost 65% of dermatologists were not satisfied with the treatment of severe PN. The study authors noted some limitations, as the survey does not represent all dermatologists in Japan treating PN. However, they expressed that more effective medications and diagnostic tools are needed in Japan to better manage severe PN symptoms.²

International Journal of Dermatology: Association between Atopic Dermatitis and Prurigo Nodularis: ASystematic Review and Meta-Analysis

Li et al completed a systemic review that observes the relationship between atopic dermatitis (AD) and prurigo nodularis. Previously, the connection between the two conditions had not been fully determined. However, this meta-analysis emphasizes the close association between AD and PN. The researchers searched databases such as PubMed, EMBASE, Scopus, and the Cochrane Library, for studies published up to February 2024. It was found that there is an increased risk of developing AD in patients already suffering from PN (pooled unadjusted odds ratio [OR], 16.85; 95% confidence interval [CI], 6.13–46.31; I2 = 100%). Similarly, PN was prevalent in patients who already had AD(2.00%; 95% CI, 1.62–2.37%). This research furthers the suggestion that PN may be a distinct clinical phenotype of AD. The study authors believe that further studies are needed to confirm these findings and determine how they can impact clinical strategies for treatment of both diseases.³

Journal of Dermatological Treatment: Estimating the Healthcare Burden of Prurigo Nodularis in England: a CPRD DatabaseStudy 

A recent study characterizes the health care burden associated with PN, specifically in England. Bahloul et al analyzed how cost can impact the availability of treatments and affect how patients and clinicians make decisions regarding disease management, with a concentration on moderate-to-severe PN. The trial, held from April 2007 to March 2019, included 8,933 adult patients from the Clinical Practice Research Datalink and the linked Hospital Episode Statistics utilizing medical codes for PN. Each patient partook in a 180-day washout period and followed up for at least 1 year. On average, patients with PN had a primary care visit rate of 14.27 visits per patient year (PPY), at a cost of £359 per year. Patients also visited outpatient departments at a rate of 6.68 PPY, costing £755 per year, with dermatology outpatient visits specifically occurring at 1.76 PPY and costing £165 per year. These numbers nearly doubled in patients with moderate to severe PN, as they require more frequent visits. Patients with moderate to severe PN also had a significantly higher rate of hospitalizations. According to investigators, the study may have been limited by non-universal diagnosis and coding of PN. Nonetheless, the research confirms the high disease burden in England and suggests more advanced therapies for the treatment of PN.⁴

What new studies have you published? Share with us by emailing  DTEditor@mmhgroup.com for an opportunity to be featured. 

References

1. Lee J, Kim Y, Shin K, et al. Treatment with upadacitinib in refractory prurigo nodularis: A prospective cohort study. Allergy Asthma Immunol Res. 2024;16(5):546-554. doi:10.4168/aair.2024.16.5.546

2. Murota H, Matsumoto M, Arima K, Yoshida T, Fujita H. Current clinical practice of prurigo nodularis in Japan: A cross-sectional web-survey among dermatologists. J Dermatol. Published online September 3, 2024. doi:10.1111/1346-8138.17400

3. Li W, Pi Y, Xu J. Association between atopic dermatitis and prurigo nodularis: a systematic review and meta-analysis. Int J Dermatol. Published online September 29, 2024. doi:10.1111/ijd.17493

4. Bahloul D, Hudson R, Balogh O, et al. Estimating the healthcare burden of prurigo nodularis in England: a CPRD database study. J Dermatolog Treat. 2024;35(1):2367615. doi:10.1080/09546634.2024.2367615