D1.367 - Dupilumab for refractory pruritus in hematological and non-hematological malignancies – preliminary results

Background:Pruritus is a challenging and debilitating symptom in hematological and non-hematological malignancies, with limited effective treatments. Interleukins 4 and 13 play key roles in the pruritic signaling cascade, closely linked to IL-31 activity. Dupilumab, a monoclonal antibody targeting IL-4Rα, offers potential relief by modulating this pathway. Our objective was to evaluate the efficacy of dupilumab in treating malignancy-associated and treatment-induced pruritus

This prospective, randomized, single-blind, single-center study enrolled patients with refractory pruritus secondary to oncologic or hemato-oncologic conditions. Patients were randomized into two groups: Group 1 received placebo for 4 weeks; Group 2 for 8 weeks. Both groups subsequently received dupilumab (600 mg loading dose, followed by 300 mg biweekly for 8 weeks). Pruritus severity was assessed using the '5-D Itch Questionnaire' at each visit.

Nine patients were enrolled; seven completed the study and their data was analyzed. Two patients withdrew during the placebo phase. Group 1 showed a significant pruritus reduction, with a 6.25-point average decrease in '5-D Itch' scores during dupilumab treatment compared to placebo. Group 2 showed no significant change. Overall, 71% (5/7) responded to dupilumab, with effects observed two weeks post-loading dose and plateauing by weeks 4-6. The treatment effect persisted for up to 9 months post-treatment.

Dupilumab demonstrates promising efficacy for managing malignancy-associated pruritus, providing sustained relief in most patients. Larger studies are needed to validate these findings and evaluate long-term safety.