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Kwatra SG, Bordeaux ZA, Parthasarathy V, Kollhoff AL, Alajmi A, Pritchard T, Cornman HL, Kambala A, Lee KK, Manjunath J, Ma EZ, Dillen C, Kwatra MM. Efficacy and Safety of Abrocitinib in Prurigo Nodularis and Chronic Pruritus of Unknown Origin: A Nonrandomized Controlled Trial. JAMA Dermatol 2024; 160:717-724. [PMID: 38837144 PMCID: PMC11154357 DOI: 10.1001/jamadermatol.2024.1464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/10/2024] [Indexed: 06/06/2024]
Abstract
Importance Prurigo nodularis (PN) and chronic pruritus of unknown origin (CPUO) are chronic pruritic diseases that dramatically impair quality of life, but therapeutic options are limited. Abrocitinib, a Janus kinase 1 inhibitor, represents a promising therapy for both conditions. Objective To assess the efficacy and safety of 200-mg oral abrocitinib administered once daily in adults with moderate to severe PN or CPUO. Design, Setting, and Participants This phase 2, open-label, nonrandomized controlled trial conducted between September 2021 and July 2022 took place at a single center in the US. A total of 25 adult patients with moderate to severe PN or CPUO were screened. Ten patients with PN and 10 patients with CPUO were enrolled. All 20 patients completed the 12-week treatment period, 18 of whom completed the 4-week follow-up period. Intervention Abrocitinib, 200 mg, by mouth once daily for 12 weeks. Main Outcomes and Measures The primary efficacy end point was the percent change in weekly Peak Pruritus Numerical Rating Scale (PP-NRS) scores from baseline to week 12. Key secondary end points included the percentage of patients achieving at least a 4-point reduction in weekly PP-NRS score from baseline to week 12 and the percent change in Dermatology Life Quality Index (DLQI) scores. Results A total of 10 patients with PN (mean [SD] age, 58.6 [13.1] years; all were female) and 10 patients with CPUO (mean [SD] age, 70.7 [5.6] years; 2 were female) enrolled in the study. The mean (SD) baseline PP-NRS score was 9.2 (1.0) for PN and 8.2 (1.2) for CPUO. PP-NRS scores decreased by 78.3% in PN (95% CI, -118.5 to -38.1; P < .001) and 53.7% in CPUO (95% CI, -98.8 to -8.6; P = .01) by week 12. From baseline to week 12, 8 of 10 patients with PN and 6 of 10 patients with CPUO achieved at least a 4-point improvement on the PP-NRS. Both groups experienced significant improvement in quality of life as demonstrated by percent change in DLQI scores (PN: -53.2% [95% CI, -75.3% to -31.1%]; P = .002; CPUO: -49.0% [95% CI, -89.6% to -8.0%]; P = .02). The most common adverse event among patients was acneiform eruption in 2 of 20 patients (10%). No serious adverse events occurred. Conclusions and Relevance The results of this nonrandomized controlled trial suggest that abrocitinib monotherapy may be effective and tolerated well in adults with PN or CPUO. Randomized, double-blind, placebo-controlled trials are warranted to validate these findings. Trial Registration ClinicalTrials.gov Identifier: NCT05038982.
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Affiliation(s)
- Shawn G. Kwatra
- Department of Dermatology, University of Maryland School of Medicine, Baltimore
- Maryland Itch Center, University of Maryland School of Medicine, Baltimore
| | - Zachary A. Bordeaux
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Varsha Parthasarathy
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Alexander L. Kollhoff
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ali Alajmi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thomas Pritchard
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hannah L. Cornman
- Department of Dermatology, University of Maryland School of Medicine, Baltimore
- Maryland Itch Center, University of Maryland School of Medicine, Baltimore
| | - Anusha Kambala
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Kevin K. Lee
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jaya Manjunath
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Emily Z. Ma
- Department of Dermatology, University of Maryland School of Medicine, Baltimore
- Maryland Itch Center, University of Maryland School of Medicine, Baltimore
| | - Carly Dillen
- Department of Dermatology, University of Maryland School of Medicine, Baltimore
- Maryland Itch Center, University of Maryland School of Medicine, Baltimore
| | - Madan M. Kwatra
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina
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Gopinath S, Sutaria N, Bordeaux ZA, Parthasarathy V, Deng J, Taylor MT, Marani M, Lee K, Pritchard T, Alajmi A, Adawi W, Oladipo OO, Semenov YR, Alphonse M, Kwatra SG. Reduced serum pyridoxine and 25-hydroxyvitamin D levels in adults with chronic pruritic dermatoses. Arch Dermatol Res 2023; 315:1771-1776. [PMID: 35534780 DOI: 10.1007/s00403-022-02357-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 03/29/2022] [Accepted: 04/19/2022] [Indexed: 12/01/2022]
Abstract
Little is known about the role nutritional factors play in the pathogenesis of chronic pruritic dermatoses (CPD). In this study, we analyzed nutritional deficiencies in CPD patients compared to matched controls. We conducted a population-based study from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2006. The main outcomes of the study were laboratory data on serum vitamin levels in participants who answered affirmatively to the questionnaires on CPD as well as matched healthy controls. We identified 877 cases of CPD among 9817 adults in the US aged 20 to 59 years. These findings revealed a slightly higher percentage of females with CPD. Low vitamin B6 (OR 0.697; 95% CI: 0.696-0.699, p = 0.025) and vitamin D (OR 0.794; 95% CI: 0.789-0.799, p = 0.037) levels were associated with a higher rate of CPD compared to healthy controls. Our study suggests that low levels of Vitamin B6 and Vitamin D inversely correlates with the presence of CPD. These vitamin deficiencies suggest further studies on the effect of vitamin supplementation may help in patients with CPD.
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Affiliation(s)
- Shilpa Gopinath
- Department of Dermatology, CRB II, Johns Hopkins University School of Medicine, Suite 206, 1550 Orleans Street, Baltimore, MD, 21231, USA
| | - Nishadh Sutaria
- Department of Dermatology, CRB II, Johns Hopkins University School of Medicine, Suite 206, 1550 Orleans Street, Baltimore, MD, 21231, USA
| | - Zachary A Bordeaux
- Department of Dermatology, CRB II, Johns Hopkins University School of Medicine, Suite 206, 1550 Orleans Street, Baltimore, MD, 21231, USA
| | - Varsha Parthasarathy
- Department of Dermatology, CRB II, Johns Hopkins University School of Medicine, Suite 206, 1550 Orleans Street, Baltimore, MD, 21231, USA
| | - Junwen Deng
- Department of Dermatology, CRB II, Johns Hopkins University School of Medicine, Suite 206, 1550 Orleans Street, Baltimore, MD, 21231, USA
| | - Matthew T Taylor
- Department of Dermatology, CRB II, Johns Hopkins University School of Medicine, Suite 206, 1550 Orleans Street, Baltimore, MD, 21231, USA
| | - Melika Marani
- Department of Dermatology, CRB II, Johns Hopkins University School of Medicine, Suite 206, 1550 Orleans Street, Baltimore, MD, 21231, USA
| | - Kevin Lee
- Department of Dermatology, CRB II, Johns Hopkins University School of Medicine, Suite 206, 1550 Orleans Street, Baltimore, MD, 21231, USA
| | - Thomas Pritchard
- Department of Dermatology, CRB II, Johns Hopkins University School of Medicine, Suite 206, 1550 Orleans Street, Baltimore, MD, 21231, USA
| | - Ali Alajmi
- Department of Dermatology, CRB II, Johns Hopkins University School of Medicine, Suite 206, 1550 Orleans Street, Baltimore, MD, 21231, USA
| | - Waleed Adawi
- Department of Dermatology, CRB II, Johns Hopkins University School of Medicine, Suite 206, 1550 Orleans Street, Baltimore, MD, 21231, USA
| | - Olusola O Oladipo
- Department of Dermatology, CRB II, Johns Hopkins University School of Medicine, Suite 206, 1550 Orleans Street, Baltimore, MD, 21231, USA
| | - Yevgeniy R Semenov
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Martin Alphonse
- Department of Dermatology, CRB II, Johns Hopkins University School of Medicine, Suite 206, 1550 Orleans Street, Baltimore, MD, 21231, USA
| | - Shawn G Kwatra
- Department of Dermatology, CRB II, Johns Hopkins University School of Medicine, Suite 206, 1550 Orleans Street, Baltimore, MD, 21231, USA.
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Ren C, Kang D, Zhang M. The association between pruritic dermatoses and inflammatory factors on sleep disorders: a cross-sectional study of the National Health and Nutrition Examination Survey (NHANES). Biotechnol Genet Eng Rev 2023:1-16. [PMID: 37130222 DOI: 10.1080/02648725.2023.2202988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Pruritic dermatoses and sleep disorders have significant impacts on the health and quality of life of patients. Inflammatory conditions may lead to the sensation of itching. This study was to evaluate the association between pruritic dermatoses and inflammatory factors on sleep disorders. Data in the cross-sectional study were extracted from the National Health and Nutrition Examination Survey. The study population was divided into participants with and without sleep disorders. Pruritic dermatoses were assessed by the participant's self-report. Inflammatory factors included white blood cell count (WBC), lymphocyte count (LYM) and prognostic nutritional index (PNI). Logistic regression models were used with odds ratios and confidence intervals. The attributable proportion of interaction (AP) was utilized to assess the interaction between pruritic dermatoses and inflammatory factors on sleep disorders. Totally, 3,520 participants were included and 214 (6.08%) had sleep disorders. Pruritic dermatoses were associated with sleep disorders after adjusting for gender, age, race, marital status, body mass index, drinking, smoking, asthma, hay fever, allergy, depression and caffeine. LYM was associated with sleep disorders when inflammatory factors were divided by median. The interaction between participants without pruritic dermatoses and PNI < median on sleep disorders was observed compared to participants without pruritic dermatoses and PNI > median. Pruritic dermatoses were significantly associated with sleep disorders. We also found that a high level of PNI had an enhanced effect on the relationship between pruritic dermatoses and sleep disorders. Clinicians should focus on the potential sleep-related risks and changes in inflammatory factors in patients with pruritic dermatoses and intervene in time.
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Affiliation(s)
- Chun Ren
- Department of Dermatology, Wujin Hospital Affiliated with Jiangsu University, Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, P. R. China
| | - Dinghua Kang
- Department of Dermatology, Wujin Hospital Affiliated with Jiangsu University, Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, P. R. China
| | - Minjie Zhang
- Department of Dermatology, The First People's Hospital of Taicang, Taicang Affiliated Hospital of Soochow University, Taicang, Jiangsu, P. R. China
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Blauvelt A, Kircik L, Papp KA, Simpson EL, Silverberg JI, Kim BS, Kwatra SG, Kuligowski ME, Venturanza ME, Wei S, Szepietowski JC. Rapid pruritus reduction with ruxolitinib cream treatment in patients with atopic dermatitis. J Eur Acad Dermatol Venereol 2023; 37:137-146. [PMID: 36066323 PMCID: PMC10087253 DOI: 10.1111/jdv.18571] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/27/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ruxolitinib cream is a topical formulation of ruxolitinib, a Janus kinase (JAK) 1/JAK2 inhibitor. OBJECTIVES To report timing and magnitude of effect of ruxolitinib cream on itch in patients with atopic dermatitis (AD), a highly pruritic inflammatory skin disease. METHODS Two phase 3 trials (TRuE-AD1 [NCT03745638]/TRuE-AD2 [NCT03745651]) enrolled patients aged ≥12 years with AD for ≥2 years, Investigator's Global Assessment score of 2 or 3, and 3%-20% affected body surface area. Patients (total N = 1249; median age, 32 years) were randomised (2:2:1) to twice daily 0.75% ruxolitinib cream, 1.5% ruxolitinib cream or vehicle cream for 8 weeks of double-blinded treatment. Worst itch was measured using the numerical rating scale (NRS). RESULTS Significantly more patients who applied ruxolitinib cream (either strength) achieved a ≥2-point itch reduction (NRS2) within approximately 12 h versus vehicle (0.75%/1.5% ruxolitinib cream, 16.3%/13.1%; vehicle, 6.9%; both P < 0.05), with further improvements through Week 8 (58.3%/65.1% vs 29.4%; both P < 0.0001). A ≥4-point itch reduction (NRS4) was achieved by significantly more patients who applied 0.75%/1.5% ruxolitinib cream versus vehicle by Day 2 (8.9%/11.2% vs 2.1%; P < 0.005); higher rates were observed at Week 8 (41.5%/51.5% vs 15.8%; P < 0.0001). Median time for the 0.75%/1.5% ruxolitinib cream groups to achieve NRS4 from baseline was 15.0/13.0 days; this endpoint was not reached by the vehicle group. CONCLUSIONS Ruxolitinib cream demonstrated rapid improvement in itch in patients with mild to moderate AD that was sustained for 8 weeks. Significantly more patients applying ruxolitinib cream achieved itch NRS2 within approximately 12 h and itch NRS4 by Day 2 versus vehicle.
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Affiliation(s)
| | - Leon Kircik
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kim A Papp
- K. Papp Clinical Research and Probity Medical Research, Waterloo, Ontario, Canada
| | - Eric L Simpson
- Oregon Health & Science University, Portland, Oregon, USA
| | | | - Brian S Kim
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shawn G Kwatra
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | | | - Jacek C Szepietowski
- Department of Dermatology, Venereology, and Allergology, Wroclaw Medical University, Wroclaw, Poland
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Fong TCT, Ho RTH, Yau JCY. Longitudinal associations between salivary cortisol to C-reactive protein ratios and psychological well-being in Chinese adults. Psychoneuroendocrinology 2022; 143:105824. [PMID: 35689984 DOI: 10.1016/j.psyneuen.2022.105824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Salivary C-reactive protein (CRP) could be a viable biomarker of inflammation and has been associated with stress outcomes. The hypothalamic-pituitary-adrenal axis can modulate stress-related inflammation. This study aimed to evaluate the interaction effects of immune-endocrine markers on psychological outcomes. METHODS The study participants were 52 healthy Chinese adults who collected 10 saliva samples over 2 consecutive days at baseline. The participants completed validated measures on anxiety, depression, positive affect, and sleep disturbance at baseline and 1 month later. The stability and diurnal patterns of salivary cortisol and CRP were investigated via paired t-tests and repeated-measures analyses of variance. Regression analysis was used to examine the longitudinal associations between immune-endocrine markers and their interactions (cortisol [Cort]: morning CRP [CRPmorn] and Cort:CRPeven) and psychological measures. RESULTS Salivary cortisol and CRP displayed satisfactory stability over 2 consecutive days and diurnal patterns of abrupt and gradual decline during the day, respectively. Controlling for baseline psychological measures and confounding variables, Cortmorn and diurnal cortisol slope was significantly and negatively associated with anxiety symptoms and positive affect 1 month later, respectively. Cort:CRPeven and Cort:CRPmorn was significantly and positively associated with depressive symptoms and sleep disturbance 1 month later, respectively. CONCLUSION These findings offer initial support for the prognostic utility of salivary cortisol and CRP and their balance as determinants of psychological health in healthy adults.
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Affiliation(s)
- Ted C T Fong
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong
| | - Rainbow T H Ho
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong; Dept of Social Work & Social Administration, The University of Hong Kong, Hong Kong.
| | - Joshua C Y Yau
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong
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Sahu M, Tripathi R, Jha NK, Jha SK, Ambasta RK, Kumar P. Cross talk mechanism of disturbed sleep patterns in neurological and psychological disorders. Neurosci Biobehav Rev 2022; 140:104767. [PMID: 35811007 DOI: 10.1016/j.neubiorev.2022.104767] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/20/2022] [Accepted: 07/01/2022] [Indexed: 11/25/2022]
Abstract
The incidence and prevalence of sleep disorders continue to increase in the elderly populace, particularly those suffering from neurodegenerative and neuropsychiatric disorders. This not only affects the quality of life but also accelerates the progression of the disease. There are many reasons behind sleep disturbances in such patients, for instance, medication use, nocturia, obesity, environmental factors, nocturnal motor disturbances and depressive symptoms. This review focuses on the mechanism and effects of sleep dysfunction in neurodegenerative and neuropsychiatric disorders. Wherein we discuss disturbed circadian rhythm, signaling cascade and regulation of genes during sleep deprivation. Moreover, we explain the perturbation in brainwaves during disturbed sleep and the ocular perspective of neurodegenerative and neuropsychiatric manifestations in sleep disorders. Further, as the pharmacological approach is often futile and carries side effects, therefore, the non-pharmacological approach opens newer possibilities to treat these disorders and widens the landscape of treatment options for patients.
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Affiliation(s)
- Mehar Sahu
- Molecular Neuroscience and Functional Genomics Laboratory, Delhi Technological University (Formerly Delhi College of Engineering), Delhi, India
| | - Rahul Tripathi
- Molecular Neuroscience and Functional Genomics Laboratory, Delhi Technological University (Formerly Delhi College of Engineering), Delhi, India
| | - Niraj Kumar Jha
- Department of Biotechnology, School of Engineering & Technology (SET) Sharda University, UP, India
| | - Saurabh Kumar Jha
- Department of Biotechnology, School of Engineering & Technology (SET) Sharda University, UP, India.
| | - Rashmi K Ambasta
- Molecular Neuroscience and Functional Genomics Laboratory, Delhi Technological University (Formerly Delhi College of Engineering), Delhi, India
| | - Pravir Kumar
- Molecular Neuroscience and Functional Genomics Laboratory, Delhi Technological University (Formerly Delhi College of Engineering), Delhi, India.
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Anwar F, Alhayyani S, Al‐Abbasi FA, Nadeem MS, Kumar V. Pharmacological role of Vitamin C in stress‐induced cardiac dysfunction via alteration in Gut microbiota. J Biochem Mol Toxicol 2022; 36:e22986. [DOI: 10.1002/jbt.22986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 10/22/2021] [Accepted: 01/05/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Firoz Anwar
- Department of Biochemistry, Faculty of Sciences King Abdulaziz University Jeddah Kingdom of Saudi Arabia
| | - Sultan Alhayyani
- Department of Chemistry College of Sciences and Arts, King Abdulaziz University Rabigh Saudi Arabia
| | - Fahad A. Al‐Abbasi
- Department of Biochemistry, Faculty of Sciences King Abdulaziz University Jeddah Kingdom of Saudi Arabia
| | - Muhammad Shahid Nadeem
- Department of Biochemistry, Faculty of Sciences King Abdulaziz University Jeddah Kingdom of Saudi Arabia
| | - Vikas Kumar
- Natural Product Discovery Laboratory, Department of Pharmaceutical Sciences Shalom Institute of Health and Allied Sciences, SHUATS Allahabad Uttar Pradesh India
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Roh YS, Choi J, Sutaria N, Kwatra SG. Itch: Epidemiology, clinical presentation, and diagnostic workup. J Am Acad Dermatol 2022; 86:1-14. [PMID: 34428534 PMCID: PMC8678917 DOI: 10.1016/j.jaad.2021.07.076] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/24/2021] [Accepted: 07/28/2021] [Indexed: 01/03/2023]
Abstract
Itch, or pruritus, is the uncomfortable sensation underlying the desire to scratch. Itch is a very common complaint in the general population that can result from dermatologic, systemic (eg, renal, hepatobiliary, endocrine), paraneoplastic, neuropathic, and psychogenic etiologies. Chronic itch is associated with significant sleep disturbances and profoundly reduces overall quality of life. Certain populations, including elderly and African Americans, are at increased risk of experiencing heightened burden of itch. Because of the variable clinical presentation and wide-ranging etiologies, itch presents a challenge for clinicians. The initial evaluation should include a complete blood count, with differential, hepatic, renal, and thyroid function testing along with diabetes screening. Further testing should be guided by history and physical examination findings. There should be a heightened concern for underlying malignancy in individuals older than 60 years of age who have a history of liver disease and diffuse itch less than 12 months of duration. For individuals with chronic pruritus of unknown origin, increased blood eosinophils may serve as a biomarker of T helper cell type 2 polarization and response to immunomodulator therapies. In this first part of a 2-part continuing medical education series, we describe the broader epidemiology and specific conditions associated with itch and the clinical presentation and diagnostic workup for patients with itch.
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Affiliation(s)
- Youkyung S. Roh
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin Choi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nishadh Sutaria
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shawn G. Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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A New Era with the Development of Cytokine-Based Therapy for Pruritus. J Invest Dermatol 2021; 142:47-52. [PMID: 34801247 DOI: 10.1016/j.jid.2021.09.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 12/12/2022]
Abstract
Pruritus is a common dermatological condition and negatively impacts QOL. Persistent pruritus and excessive scratching behavior can lead to the itch-scratch cycle that exacerbates inflammatory skin diseases. Conventional antipruritic drugs, such as antihistamines, corticosteroids, or anticonvulsants, are sometimes insufficient. Recently, however, molecularly targeted drugs, such as IL-31 or IL-4 receptor-targeting antibodies, have become available or are under clinical trials, dramatically changing the clinical situation. In fact, some of these drugs can improve pruritus without the need for topical steroids. Taken together, these observations point to the importance of cytokine-mediated pruritus, further understanding of which may guide improved therapies.
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Real-world comorbidities of atopic dermatitis in the U.S. adult ambulatory population. J Am Acad Dermatol 2021; 86:835-845. [PMID: 34800600 DOI: 10.1016/j.jaad.2021.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/04/2021] [Accepted: 11/10/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is a pruritic inflammatory skin disease associated with various comorbidities. However, comprehensive analyses of real-world comorbidities in adult AD patients are limited. OBJECTIVE To characterize the real-world comorbidities associated with adult AD in an ambulatory population. METHODS We queried the MarketScan Commercial Claims and Encounters database from January 1, 2017 to December 31, 2017. Multivariable logistic regressions were performed to compare comorbidities in adult AD patients vs. age- and sex-matched controls. RESULTS A total of 39,779 AD patients and 353,743 controls were identified. Increased odds of psychiatric conditions including anxiety (OR 1.44) and mood disorders (OR 1.31) were observed in AD. AD patients had higher likelihood of autoimmune diseases including vitiligo (OR 4.44) and alopecia areata (OR 6.01). Adult AD was also associated with infections including impetigo (OR 9.72), MRSA (OR 3.92), and cellulitis (OR 2.52). AD patients were more likely to have systemic conditions including lymphoid/hematopoietic malignancy (OR 1.91), atherosclerosis (OR 1.69), and metabolic syndrome (OR 1.47). For all the above, p<0.001. LIMITATIONS Retrospective analysis of healthcare claims data CONCLUSIONS: Adult AD is associated with various psychiatric and systemic comorbidities, emphasizing the systemic nature of AD and the need for collaborative management of these patients.
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11
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Nocturnal pruritus and sleep disturbance associated with dermatologic disorders in adult patients. Int J Womens Dermatol 2021; 7:403-410. [PMID: 34632036 PMCID: PMC8484989 DOI: 10.1016/j.ijwd.2021.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 11/22/2022] Open
Abstract
Nocturnal pruritus (NP) is a relatively common reason for dermatologic consultation. Its pathophysiology is partially understood. Skin conditions such as atopic dermatitis, psoriasis, urticaria, and prurigo nodularis are well-described causes of NP. The most distressing sequela of NP is sleep deficit, which can lead to physical and mental disturbances (e.g., daytime somnolence and fatigue) and negative emotional states that profoundly affect quality of life. However, this aspect of NP is often overlooked by dermatologists. It is essential to assess sleep quality in such patients and adopt appropriate measures to arrest the problem at an early stage. We conducted an evidence-based literature review to highlight the pathogenetic mechanisms of NP, identify dermatologic etiologies, and explore methods that have been used to assess the quality of sleep. Furthermore, we performed a systematic review of studies on sleep disturbance relevant to NP in patients with dermatologic conditions. Finally, we discuss the evidence on treatment options for NP and indicate therapies that may target both NP and sleep disturbance.
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Roh YS, Choi J, Sutaria N, Belzberg M, Kwatra MM, Kwatra SG. IL-31 Inhibition as a Therapeutic Approach for the Management of Chronic Pruritic Dermatoses. Drugs 2021; 81:895-905. [PMID: 33881741 DOI: 10.1007/s40265-021-01521-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
Chronic pruritus is a debilitating symptom with limited treatment options. Identifying molecular targets underlying chronic pruritic dermatoses is essential for the development of novel, targeted therapies. IL-31 is an important mediator of itch by integrating dermatologic, neural, and immune systems. IL-31 helps induce and maintain chronic pruritus via both indirect stimulation of inflammatory cells and through direct neural sensitization. IL-31 is overexpressed in various chronic pruritic skin conditions, and exogenous IL-31 induces itch and scratching behavior. Studies have demonstrated that IL-31R and IL-31 antagonism significantly reduces itch in patients with atopic dermatitis and prurigo nodularis, two extremely pruritic skin conditions. Emerging evidence, including recent phase II clinical trials of IL-31R antagonists, demonstrates that IL-31 plays an important role in itch signaling. Additional studies are ongoing to evaluate IL-31R and IL-31 antagonism as treatments of chronic pruritus.
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Affiliation(s)
- Youkyung S Roh
- Department of Dermatology, John Hopkins University School of Medicine, Cancer Research Building II Suite 206, 1550 Orleans Street, Baltimore, MD, 21231, USA
| | - Justin Choi
- Department of Dermatology, John Hopkins University School of Medicine, Cancer Research Building II Suite 206, 1550 Orleans Street, Baltimore, MD, 21231, USA
| | - Nishadh Sutaria
- Department of Dermatology, John Hopkins University School of Medicine, Cancer Research Building II Suite 206, 1550 Orleans Street, Baltimore, MD, 21231, USA
| | - Micah Belzberg
- Department of Dermatology, John Hopkins University School of Medicine, Cancer Research Building II Suite 206, 1550 Orleans Street, Baltimore, MD, 21231, USA
| | - Madan M Kwatra
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Shawn G Kwatra
- Department of Dermatology, John Hopkins University School of Medicine, Cancer Research Building II Suite 206, 1550 Orleans Street, Baltimore, MD, 21231, USA.
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Kabashima K, Irie H. Interleukin-31 as a Clinical Target for Pruritus Treatment. Front Med (Lausanne) 2021; 8:638325. [PMID: 33644103 PMCID: PMC7906974 DOI: 10.3389/fmed.2021.638325] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/14/2021] [Indexed: 12/22/2022] Open
Abstract
In recent years, the published literature has suggested the key involvement of the cytokine interleukin-31 (IL-31) in the symptomatology of pruritus, and both IL-31 and its receptor have become potential therapeutic targets for a range of pruritic diseases. Elevated levels of IL-31 or its receptor have been reported in the tissue or serum of patients with pruritic skin diseases, such as atopic dermatitis, prurigo nodularis, and psoriasis. Pruritus places a heavy burden on patients, and can have a negative impact on daily life, sleep, and mental health. Since current anti-pruritic treatments are often ineffective, affected patients are in urgent need of new therapies. As a result, drug development targeting the IL-31 pathway is evolving rapidly. To date, only nemolizumab, a humanized monoclonal antibody targeting the IL-31 receptor, has successfully completed late-stage clinical studies. This article will highlight our current clinical understanding of the role of IL-31 in pruritic disease, and explore recent progress in drug development as well as the anticipated future advances in this field.
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Affiliation(s)
- Kenji Kabashima
- Department of Dermatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroyuki Irie
- Department of Dermatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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