Nemolizumab

How it works

It binds the interleukin-31 receptor alpha subunit, blocking IL-31 signalling — a key cytokine in the itch and neuroinflammatory pathways of these conditions.

Prescribing in practice

• Assess for active infection before starting and avoid live vaccines during treatment, in keeping with biologic immunomodulators.
• Peripheral oedema and, in atopic dermatitis, occasional early worsening of eczema or asthma-related symptoms have been reported.
• Administer by subcutaneous injection and, in atopic dermatitis, it is generally used alongside topical therapy.

Monitoring

Monitoring is clinical, tracking reduction in itch and skin lesions and reviewing for infection, oedema or respiratory symptoms.

Counselling the patient

• The main benefit is reduction of itch, which can improve sleep and skin healing over time.
• Report signs of infection or any new swelling or breathing symptoms.
• Continue any prescribed topical treatments and emollients alongside the injections.

Evidence & guidelines

Nemolizumab's efficacy in prurigo nodularis and atopic dermatitis was demonstrated in the OLYMPIA and ARCADIA phase 3 trial programmes.