治疗慢性瘙痒症:我们处于突破的临界点吗?

Payton Smith
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摘要

慢性瘙痒症的特点是持续瘙痒超过六周,影响人群高达 15%,严重影响生活质量。尽管慢性瘙痒症发病率高、影响大,但美国食品及药物管理局(FDA)却没有批准专门用于治疗慢性瘙痒症的药物,这凸显了皮肤病学尚未满足的巨大需求。然而,皮肤科药物的进步,包括生物制剂和酪氨酸激酶(JAK)抑制剂的开发,预示着通过完全不同的作用机制(主要是对神经系统的影响)在瘙痒症治疗方面可能取得突破。目前,治疗瘙痒症最常用的方法是镇静抗组胺药,但这些药物对非组胺诱发的瘙痒症基本无效,这凸显了采用新方法的必要性。这篇社论回顾了主要研究和临床试验,尤其关注结节性瘙痒症病例,因为瘙痒是结节性瘙痒症的主要病理变化,而不仅仅是一种症状。Dupilumab在III期试验中治疗结节性瘙痒症的疗效与它对皮炎或特应性背景的影响无关,同时JAK抑制剂在治疗慢性特发性瘙痒症方面也取得了成功,这表明治疗方法正在转向直接和特异性地针对瘙痒神经通路,而不是通过免疫系统调节或镇静作用间接地针对瘙痒神经通路。这些进展表明,治疗慢性瘙痒症的重大进展可能即将到来,为皮肤科头号致病原因--瘙痒症患者带来了希望。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Treating Chronic Pruritus: Are We at the Threshold of a Breakthrough?
Chronic pruritis, characterized by persistent itchiness lasting more than six weeks, affects up to 15% of the population, significantly impairing quality of life. Despite its prevalence and impact, there is an absence of FDA-approved medications specifically for the treatment of chronic pruritus, highlighting a significant unmet need in dermatology. Advancements in dermatologic medications, however, including the development of biologics and Janus kinase (JAK) inhibitors, signal potential breakthroughs in pruritus management through a radically different mechanism of action that focuses on their effect on the nervous system. Currently, the most commonly utilized treatments for pruritis are sedating antihistamines, which have been largely ineffective for non-histamine-induced itch, underscoring the necessity for novel approaches. This editorial reviews key studies and clinical trials with a particular focus on cases of prurigo nodularis, where itch serves as the primary pathology rather than just a symptom. The effectiveness of dupilumab in phase III trials for treating prurigo nodularis, independent of its effects on dermatitis or atopic background, alongside the success of JAK inhibitors in managing chronic idiopathic pruritus, indicates a shift towards therapies that directly and specifically target itch nerve pathways instead of indirectly via immune system modulation or sedation. These developments suggest that significant progress may be on the horizon for treating chronic itch, providing hope for those suffering from pruritis, the number one cause of misery in dermatology.
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