Characteristics of Suitable Cases for Nemolizumab Treatment Based on Clinical Findings and Cutaneous Adverse Events

Academic Background

Atopic Dermatitis (AD) is a common chronic inflammatory skin disease, characterized by intense itching that significantly impacts patients’ quality of life. In recent years, treatment methods for AD have advanced, with Nemolizumab, a monoclonal antibody targeting the Interleukin-31 receptor (IL-31RA), demonstrating significant efficacy in alleviating itching. However, compared to other systemic therapies, Nemolizumab has a higher incidence of Cutaneous Adverse Events (CAEs), which limits its widespread clinical application. Therefore, studying the adverse reactions associated with Nemolizumab treatment and their relationship with patients’ baseline conditions is crucial for optimizing treatment plans and improving patient compliance.

Source of the Paper

This paper was authored by Akiko Sugiyama and colleagues from the Department of Allergology and Dermatology at the NHO Fukuoka National Hospital and the Department of Dermatology at Kyushu University Graduate School of Medical Sciences. Published in the Journal of Dermatology in 2025, the DOI is 10.¹¹¹¹⁄₁₃₄₆-8138.17626.

Research Process

Study Subjects and Data Collection

The study retrospectively collected data from AD patients who began Nemolizumab treatment between May 2023 and September 2024. Inclusion criteria required patients to have completed at least three doses of Nemolizumab and have follow-up records. A total of 25 AD patients (11 males, 14 females) with an average age of 17.0±11.1 years were included. Data collected included Eczema Area and Severity Index (EASI) scores before Nemolizumab treatment, types and timing of CAEs, number of Nemolizumab doses, treatment continuation status, and any changes in systemic therapy.

Data Analysis

Patients were divided into continuation and discontinuation groups, and EASI scores for different body areas (head/neck, trunk, upper extremities, lower extremities) before treatment were compared between the two groups. T-tests were used to analyze differences in trunk erythema, edema/papulation, excoriation, and lichenification scores.

Key Findings

Occurrence of CAEs and Treatment Continuation

Among the 25 patients, 20 (80%) experienced CAEs, primarily manifesting as dry desquamation, nummular eczema, and edematous erythema. Of these, 13 patients had their CAEs controlled and continued Nemolizumab treatment, while 7 patients discontinued treatment and switched to other systemic therapies due to adverse events.

Relationship Between Trunk EASI Scores and Treatment Continuation

The study found that patients in the discontinuation group had significantly higher pre-treatment trunk erythema and edema/papulation scores compared to the continuation group (erythema: 1.71±0.39 vs. 1.25±0.39, p=0.021; edema/papulation: 1.71±0.39 vs. 1.08±0.65, p=0.025). Additionally, the trunk excoriation score in the discontinuation group showed a higher trend (p=0.058). No significant differences were observed in EASI scores for other body areas between the two groups.

Conclusions and Significance

The study indicates that patients with milder trunk eruptions before Nemolizumab treatment are more likely to continue therapy and manage CAEs effectively. This finding provides clinicians with important guidance for selecting suitable candidates for Nemolizumab treatment, thereby improving treatment success rates and patient compliance.

Research Highlights

1. First Systematic Analysis of the Relationship Between CAEs and Baseline Conditions in Nemolizumab Treatment: Through retrospective analysis, the study revealed the association between trunk eruption severity and the likelihood of continuing Nemolizumab treatment.
2. Guidance for Clinical Treatment: The results suggest that Nemolizumab may be a long-term effective treatment option for patients with milder trunk eruptions.
3. Timely Management of Adverse Events: The study emphasizes the importance of enhanced topical steroid application in the early stages of Nemolizumab treatment to control the occurrence and progression of CAEs.

Additional Valuable Information

The study also found that some patients experienced rapid improvement in CAEs after switching to Dupilumab or Lebrikizumab, suggesting that elevated IL-4 and IL-13 levels might be a cause of Nemolizumab’s adverse events. This finding provides clues for further research into Nemolizumab’s mechanism of action.