New and Emerging Pharmacotherapies for Pruritus: A Systematic Review and Network Meta-Analysis

Chronic pruritus, a common symptom of dermatologic diseases, impairs quality of life. No review exists that evaluates the efficacy of emerging therapies based on a single standardized scale. We assessed efficacy and adverse effects of novel treatments available for pruritus in patients diagnosed with common pruritic diseases using the proportions of patients experiencing a ≥4-point reduction as a standardized efficacy measure between studies. We searched PubMed, Web of Science, Embase, and Cochrane Central Register of Controlled Trials for phase II or III trials reporting change in numerical rating scale following interventions for pruritus from 2015 to 2023. The strongest improvements in pruritus were seen from ustekinumab (RR 4.30 [2.88; 6.41]) and ixekizumab (RR 4.42 [3.32; 5.88]) for psoriasis and upadacitinib (RR 5.54 [95% CI: 4.53-6.78]), abrocitinib (RR 3.76 [95% CI: 2.97-4.76]), and baricitinib (RR 3.63 [95% CI: 2.36-5.58]) for atopic dermatitis. Nemolizumab (RR 3.06 [95% CI: 1.63-5.74]) and dupilumab (RR 2.11 [95% CI: 1.30-3.41]) were most effective for prurigo nodularis, though fewer studies were available for comparison. Adverse effects were mild and similar between agents; discontinuation rates were low. This review evaluates efficacy of emerging pruritus treatments based on a single standardized measurement, highlighting the role of novel agents in the treatment of chronic pruritus.