The US Food and Drug Administration (FDA) approval last year of nemolizumab for the treatment of adults with prurigo nodularis (PN) was likely only the beginning of a dramatically changing therapeutic landscape for that condition, Sonja Stander, MD, IFAAD, said at the 2025 American Academy of Dermatology (AAD) Annual Meeting in Orlando, Florida.
Presenting “Updates in the Treatment Landscape of Prurigo Nodularis,” Dr. Stander noted that the FDA approval of dupilumab in 2022 was the first for systemic therapy for PN in the 113 years since the condition was first described. Nemolizumab represented another major step, and now the pharmaceutical pipeline for PN comprises six different mechanisms of action.
“The pipeline is not at the end,” Dr. Stander said.
Nemolizumab achieving lesion clearance in more than 26% of patients in phase 3 trials is “very convincing,” Dr. Stander said, noting that the endpoint of lesion clearance is very difficult to achieve.
“Patients are allowed only to have up to five nodules [for it to be considered lesion clearance]; they come from at least 20, [with] most around 70 nodules,” she said. “To achieve this within 16 weeks is, for me, still very surprising and exciting. We [also] have long-term data showing a very stable and high anti-pruritic effect.”
The new drugs in the pipeline should only improve treatment capabilities for patients with PN, Dr. Stander added.
“Last year, there was a lot of noise, a lot of studies that have been initiated with different mechanisms,” she said. “An anti-KIT antibody. We see JAK inhibitors. We see totally new modes of action. Interleukin-1 receptor-associated kinase 4 [IRAK4] modulators. Then we see OX40. We see that there are some more interleukin-4 receptor antibodies in the pipeline [along with interleukin-31 receptor antibodies]. So this is not the end. The story is going on. We have a few different cells and targets. We will see at the end what is the efficacy, what is the control on the itch, on the lesions? And hopefully we have more approved therapies for this very burdensome disease.”