ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
IL-31 Receptor Alpha (IL-31RA) Inhibitor Pregnancy: Avoid — insufficient data; effective contraception recommended during treatment

Nemolizumab

Brand names: Nemluvio

Adult dose

Dose: Prurigo nodularis: 60 mg SC every 4 weeks; Atopic dermatitis: 30 mg SC every 4 weeks
Route: Subcutaneous injection
Frequency: Every 4 weeks
Max: 60 mg per dose
Moderate-severe prurigo nodularis (PN) and atopic dermatitis; targets IL-31RA — IL-31 is the key pruritogenic (itch-causing) cytokine; first licensed treatment for prurigo nodularis in UK

Paediatric dose

Dose: Not established N/A/kg
Route: N/A
Frequency: N/A
Max: N/A
Not licensed in paediatrics; trials in adolescents ongoing

Dose adjustments

Renal

No dose adjustment required

Hepatic

No dose adjustment required

Paediatric weight-based calculator

Not licensed in paediatrics; trials in adolescents ongoing

Clinical pearls

  • OLYMPIA 1 and 2 trials (Yosipovitch et al. NEJM 2023): nemolizumab significantly reduced Investigator Global Assessment (IGA) and Peak Pruritus NRS in prurigo nodularis vs placebo — IGA 0/1 achieved in 56% vs 16% at week 16; transformative for PN which previously lacked evidence-based treatments
  • Prurigo nodularis (PN): characterised by intensely pruritic nodules — itch-scratch cycle drives nodule formation and chronicity; IL-31 is a key driver of itch in PN (and atopic eczema); nemolizumab breaks the itch-scratch cycle at cytokine level
  • MHRA 2024 approved for both PN and atopic dermatitis; NICE appraisal ongoing; represents first licensed targeted therapy for prurigo nodularis — previously managed with off-label agents (dupilumab, naltrexone, pregabalin, ciclosporin)
  • Distinct from dupilumab: nemolizumab targets the itch pathway specifically (IL-31), while dupilumab targets IL-4/IL-13 (the inflammation pathway); dupilumab also effective in PN but through different mechanism — combination possible in refractory cases
  • Initial itch worsening: some patients report transient increase in pruritus in first 1-2 weeks — likely due to initial cytokine redistribution; counsel patients to continue; substantial improvement typically evident by week 4

Contraindications

  • Active serious infections
  • Known hypersensitivity

Side effects

  • Injection site reactions
  • Headache
  • Musculoskeletal pain
  • Peripheral oedema
  • Atopic dermatitis flare (initial — itch may temporarily worsen in first 1-2 weeks)

Interactions

  • Live vaccines — avoid

Monitoring

  • Peak Pruritus NRS and IGA at each visit
  • Nodule count (clinical assessment)
  • Atopic dermatitis scores (EASI/SCORAD if AD indication)
  • Injection site reactions

Reference: BNFc; BNF 90; OLYMPIA 1 & 2 trials (Yosipovitch et al. NEJM 2023); MHRA SPC Nemluvio 2024; Silverberg et al. NEJM 2023 (AD indication); BAD Prurigo Nodularis Guideline. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Pathways