Real-World Evidence Demonstrating Nemolizumab's Rapid Efficacy in Recalcitrant Uremic Pruritus

Uremic pruritus is a common and distressing condition in patients with advanced chronic kidney disease (CKD). It often leads to disruption of sleep habits, impaired mental health, and reduced quality of life. Nemolizumab is an interleukin-31 receptor subunit alpha (IL-31R𝛼) antagonist that is currently approved to treat prurigo nodularis (PN) and atopic dermatitis (AD). However, its effectiveness in treating uremic pruritus remains uncertain, as it has only been explored in a limited number of small studies. We present a case of a 69-year-old man on long-term hemodialysis who presented with refractory uremic pruritus. The patient initially reported a pruritus numerical rating scale (NRS) score of 8 out of 10, indicating severe itch on a scale where 0 represents no itch and 10 represents the worst itch imaginable. Despite adequate six-week trials of triamcinolone acetonide 0.1% ointment twice daily, narrowband ultraviolet B (NB-UVB) phototherapy three times weekly, N-acetylcysteine (600 mg twice daily), and gabapentin (300 mg three times daily), his debilitating itch persisted. Consequently, treatment with nemolizumab was initiated. Just two weeks after the initial dose, the patient reported an NRS score of 0, indicating complete relief from pruritus, along with a reduction in excoriated lesions observed on physical examination. The patient reported no side effects from nemolizumab. This case highlights the potential of nemolizumab as an effective and safe treatment option for recalcitrant uremic pruritus. Further exploration of its therapeutic applications in this condition and other vexing-to-treat pruritic conditions is warranted.