Nemolizumab (Nemluvio)
IL-31 receptor antagonist for refractory pruritus and prurigo nodularis
About This Treatment
Nemolizumab is a humanized monoclonal antibody binding to IL-31 receptor (IL-31RA). IL-31 is a central cytokine of neuroimmune pruritis, produced by T cells, dendritic cells, and keratinocytes. Blocking the IL-31-IL-31RA axis directly suppresses itch nerve (C-fiber) activation, markedly improving refractory pruritus, prurigo nodularis, and severe pruritus in atopic dermatitis. Particularly for patients with inadequate response to conventional immunosuppressive therapy, it provides innovative treatment options.
Mechanism of Action
IL-31, a four-helix bundle cytokine produced by epithelial cells and T cells, binds IL-31 receptor complex (IL-31RA + OSMRβ). In peripheral nervous system, IL-31 receptor activation on C-fiber nerve terminals decreases desensitization, amplifying itch signal neurotransmission. Additionally, IL-31RA activation on keratinocytes promotes inflammatory cytokine (TNF-α, IL-8) production, creating a neuro-inflammatory loop. Nemolizumab, by blocking IL-31 receptor, interrupts this neuro-immune circuit and directly suppresses itch signal transmission. Particularly for neuropathic itch and chronic pruritus pathophysiology, it provides specific and effective therapeutic approach.
Indications
Expected Results
Pruritus markedly improves 2-4 weeks post-injection; most patients achieve >50% reduction in Pruritus Numerical Rating Scale (P-NRS) by 12 weeks. Particularly for refractory pruritus patients unresponsive to conventional therapy, significant QoL improvement reported.
Clinical Evidence
Risks & Side Effects
Ocular symptoms and increased infection risk not reported. Headache and upper respiratory infections mildly reported. Ocular symptoms like conjunctivitis reported less frequently than dupilumab. Pregnancy/lactation safety data limited.
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