Treatment With Upadacitinib in Refractory Prurigo Nodularis: A Prospective Cohort Study

Abstract

Prurigo nodularis (PN) is a chronic neuroinflammatory dermatosis with severe pruritus that has limited efficacy in various conventional treatments. This study investigated the outcomes of upadacitinib treatment in patients with refractory PN. A prospective study was conducted to screen for potential chronic infections prior to treatment. Upadacitinib was administered at a daily dose of 15 mg for 24 weeks, and the treatment response was assessed using the itch Numeric Rating Scale (NRS), investigator's Global Assessment (IGA), and Dermatology Life Quality Index (DLQI). Adverse events were monitored at each visit. Ten patients, with an average age of 48.8 years, were included in the study. All participants were treated with systemic cyclosporine before receiving upadacitinib, which yielded limited responses. At baseline, the mean prurigo severity scores assessed using the IGA, DLQI, and itch NRS were 3.4, 17.8, and 8.1, respectively; after 24 weeks of treatment, these scores significantly reduced to 1.0, 0.6, and 0.8, respectively. No severe adverse effects were observed. In conclusion, upadacitinib could be considered an alternative therapeutic option with good tolerability for refractory PN.

Keywords: Janus kinase inhibitors; Prurigo; prospective study; pruritus; treatment outcome.

Fig. 1. The changes in the itch NRS, IGA PN, DLQI scores at each visit. (A) Variation percentages of the itch NRS, IGA, and DLQI scores over time. The mean changes in the (B) itch NRS, (C) IGA PN, (D) DLQI scores over time.

NRS, Numeric Rating Scale; IGA PN, Investigator’s Global Assessment of Prurigo Nodularis; DLQI, Dermatologic Life Quality Index. ^∗P < 0.05, ^∗∗P < 0.001.

Fig. 2. Proportions of patients with each category of (A) the itch NRS, (B) IGA PN, (C) DLQI scores at each visit. The itch NRS and DLQI scores were stratified into 3 categories: mild, moderate, and severe (itch NRS; mild = 0–3, moderate = 4–6, severe = 7–10, DLQI; mild impairment = 0–5, moderate impairment = 6–10, severe impairment = 11–30).

NRS, Numeric Rating Scale; IGA PN, Investigator’s Global Assessment of Prurigo Nodularis; DLQI, Dermatologic Life Quality Index.

Fig. 3. Clinical photographs of a representative patient with prurigo nodularis treated with upadacitinib. Photographs were taken at (A) baseline, (B) week 4, (C) week 12, and (D) week 24.