Nemolizumab Demonstrates Marked Efficacy in Challenging Chronic Pruritus: A Real-world Multicenter Case Series

OBJECTIVE: Chronic pruritus significantly impacts quality of life and remains challenging to manage, particularly in patients unresponsive to systemic therapies. Nemolizumab, a monoclonal antibody targeting the interleukin (IL)-31 receptor, has shown promise in alleviating pruritus across several dermatologic conditions. However, data on its efficacy in treatment-resistant cases, particularly in real-world settings, remain limited. This case series evaluates the efficacy and safety of nemolizumab in patients with treatment-resistant chronic pruritus. METHODS: A multicenter retrospective review was conducted across private dermatology practices and large academic dermatology centers. Patient records were reviewed for demographics, comorbidities, treatment history, and clinical outcomes, including Body Surface Area (BSA), Investigator Global Assessment (IGA), and Peak Pruritus Numerical Rating Scale (PP-NRS). Adverse events were recorded. RESULTS: Twelve patients (5 with atopic dermatitis, 2 with prurigo nodularis, 3 with chronic pruritus of unknown origin, and 2 with concomitant atopic dermatitis and prurigo nodularis) were included. All had previously failed systemic therapies. Mean baseline BSA was 45 percent (range 5–88%), with mean PP-NRS of 9 (range 6–10). After treatment, mean BSA and PP-NRS decreased to 4 percent (11-fold reduction) and 0.9 (10-fold reduction), respectively. Most (10/12) experienced significant pruritus relief within 24 to 72 hours of nemolizumab initiation. No serious adverse events were noted, including in patients with a history of malignancy or end-stage renal disease. LIMITATIONS: Small sample size, retrospective design, limited follow-up, and absence of a control group. CONCLUSION: Nemolizumab demonstrated rapid and substantial efficacy in treatment-resistant chronic pruritus with a favorable safety profile, even in patients with significant comorbidities.