Antihistamines-refractory chronic pruritus in psoriatic patients undergoing biologics: Aprepitant Vs Antihistamine double dosage, a real-world data.
J Dermatolog Treat. 2020 Oct 21;:1-15
Authors: Damiani G, Kridin K, Pacifico A, Malagoli P, Dm Pigatto P, Finelli R, Taccone FS, Peluso L, Conic RRZ, Bragazzi NL, Dermatologists Italian Network Y, Fiore M
Abstract
BACKGROUND: Psoriasis-related pruritus-(PRP) in patients under systemic treatment is challenging. The risk to switch anti-psoriatic drug and to lose response to previous therapy is high, thus dermatologists prefer to add an anti-pruritic agent.
OBJECTIVES: To evaluate the effect of anti-histamines and aprepitant in treating PPR of psoriatic patients undergoing systemic anti-psoriatic therapies.
METHODS: A pilot observational open-label study was performed on responsive psoriatic patients with PPR under treatment. Initial therapy included oral rupatadine (10 mg/day for 30 days).In case of Epworth Sleepiness Scale(ESS) was above 14, patients were switched to aprepitant(80mg/day for 7 days),otherwise rupatadine dosage was increased(20 mg/day for 7 days).Clinical evaluation was performed at the baseline(T0) and after 7 days(T7).
RESULTS: We enrolled 40 patients with PPR, 20 in each group. Age, gender, Psoriatic arthritis(PsA) and the itch-VAS, were matched. At T7, aprepitant displayed higher improvements than rupatadine (itch-VAS= 4[3-5] vs 8.5[8-9], p< 0.01, DLQI= 14[13-16] vs. 18[16-21], p < 0.01 and ESS= 5[4-7] vs 15[14-16], p < 0.01). Doubling the rupatadine dosage from 10mg to 20mg/day only slightly improve itch (itch-VAS 9[8-10] vs 9[8-9], p = 0.03), conversely no modifications in the quality of life (DLQI 18[17-20] vs 18[17-21], p = 0.73) and increased sleepiness (ESS 10[9-11] vs 15[14-16], <0.01).
CONCLUSIONS: Aprepitant may be a valid alternative in PPR patients with ESS >14 under antihistamines.
PMID: 33084462 [PubMed - as supplied by publisher]
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