Nemolizumab-ilto—a humanized monoclonal antibody that acts as an interleukin-31 inhibitor—produced rapid and clinically meaningful reductions in itch and sleep disturbance as early as day 2 in patients with moderate-to-severe atopic dermatitis and prurigo nodularis, with treatment effects increasing through the first 14 days of therapy, according to a post hoc analysis of 4 phase 3 randomized clinical trials published in the Journal of the European Academy of Dermatology & Venereology.

Across pooled analyses, it was found that a significantly greater proportion of patients treated with nemolizumab achieved a four-point or greater improvement in itch intensity compared with placebo, and early response was associated with sustained benefit at week 16.

The analysis examined daily patient-reported outcomes from ARCADIA 1 and 2 in atopic dermatitis (AD) and OLYMPIA 1 and 2 in prurigo nodularis (PN), comprising 1,728 patients with AD and 560 with PN. Itch severity was measured using the Peak Pruritus Numerical Rating Scale (PP-NRS). The Sleep Disturbance Numerical Rating Scale (SD-NRS) was used to assess sleep disturbance. Clinically meaningful change was defined as a two-to-four-point improvement from baseline on the PP-NRS and a four-point improvement on the SD-NRS. Analyses were conducted in the intention-to-treat population, with nonresponder imputation applied after rescue therapy or missing assessments.

In pooled ARCADIA analyses, 10.7% of patients treated with nemolizumab achieved an itch response by day 2 compared with 2.9% of those receiving placebo; the researchers reported that this statistically significant difference widened through day 14, when response rates reached 25.5% and 8.9%, respectively. Similar findings were observed in PN. In pooled OLYMPIA analyses, separation between treatment groups was seen by day 2, with 17.2% of nemolizumab-treated patients achieving an itch response compared with 3.7% of those treated with placebo. By day 14, response rates increased to 37.0% in the nemolizumab group versus 10.2% in the placebo group. 

The researchers thus noted that “targeting the IL-31 pathway presents an important way to achieve rapid itch response.”

Of note, across both disease populations, patients who achieved an itch response at day 2 appeared more likely to remain responders at week 16.

Early improvements in sleep disturbance appeared to parallel itch outcomes. By day 2, a total of 9.9% of patients with AD who were treated with nemolizumab achieved a clinically meaningful improvement in sleep compared with 4.6% receiving placebo. In PN, the corresponding rates were 13.4% and 4.3%, respectively.

The analysis was post hoc, and early itch response was not a prespecified endpoint for formal hypothesis testing; therefore, reported P values were nominal and not adjusted for multiple comparisons. Responder analyses were conducted daily. In addition, background topical therapy was permitted in the AD  trials but not in those of PN. Associations between day 2 itch response and outcomes were evaluated through week 16.

"Together, these outcomes may contribute to better quality of life for patients with AD and PN," the researchers concluded. 

Full disclosures can be found in the published study.

Source: Journal of the European Academy of Dermatology & Venereology