The following is a summary of “Dupilumab Therapy Modulates Circulating Inflammatory Mediators in Patients with Prurigo Nodularis,” published in the July 2024 issue of Dermatology by Bao, et al.

Prurigo nodularis (PN) is a chronic inflammatory skin disease marked by severe itching and skin nodules. It also involves systemic inflammation that may contribute to comorbid conditions. Although dupilumab has recently been approved for PN treatment, its impact on systemic inflammation remains unclear. For a study, researchers sought to investigate changes in plasma concentrations of inflammatory proteins following dupilumab treatment in patients with PN.

In the exploratory study, plasma samples were collected from three patients with moderate-to-severe PN before and after at least six months of dupilumab treatment. All patients showed significant clinical improvements post-treatment. A total of 2,569 proteins were analyzed for differential expression, with criteria set at q < 0.1 and fold change > 1.3.

Of the proteins tested, 186 were differentially expressed after dupilumab treatment. There was a downregulation of cytokines related to T helper (Th) 1 (IFN-γ, TNF-α), Th2 (IL-4, IL-13), and Th17/Th22 (IL-6, IL-22) pathways. Markers of innate immunity (IL-19, toll-like receptor 1, nitric oxide synthase 2), immune cell migration (CCL20, CD177), and fibrosis (IL-11, IL-22) also decreased (q < 0.1). Gene set variation analysis indicated reduced expression of Th2, Th17, and epithelial-mesenchymal transition pathways in the post-treatment group (P < .05). Plasma cytokine levels of IL-11, nitric oxide synthase 2, IL-13, IL-4, and IFNG showed strong correlations with pruritus severity (R2 > 0.75, q < 0.10).

Dupilumab treatment may lower systemic inflammatory proteins linked to various immune and fibrosis pathways in patients with PN, potentially influencing the development of systemic comorbidities.

Reference: sciencedirect.com/science/article/pii/S2667026724000286