Safety considerations when using drugs to treat pruritus

ABSTRACT

Introduction: Treatment for chronic pruritus ranges from use of topical formulations to newer biologic agents. Targeting treatment to the underlying etiology is key in reducing the burden of disease while avoiding systemic or adverse effects.

Areas covered: This review details the effective medical treatments used in various etiologies of chronic itch with a focus on the potential adverse effects and safety data available for each.

Expert opinion: New drug developments in the areas of neural signaling and immune targeting show great promise for the future of chronic itch treatment. These new therapies broaden the available treatment options but also pose new considerations for safety and adverse effects.

KEYWORDS:

• Safety
• pruritus
• itch
• treatment

Article highlights

• The treatment of chronic itch must be tailored to the underlying etiology, with appropriate use of a therapeutic ladder based on disease severity.

• Topical agents provide a quick, localized relief of pruritus with limited adverse effects and favorable safety profile. However, some of these agents may have systemic effects and use is limited in cases of generalized or intractable symptoms.

• Systemic immuno-modulatory agents range from traditional immunosuppressive agents to new biologic agents that target immune components specific to the pruritic disease. Newer agents have shown initial promise in offering an improved safety profile.

• The neural system is integral to the transmission of itch signaling and can be targeted for treatment of chronic itch. Many neuro-modulating agents have been used for non-itch-related neural conditions and therefore have a well described safety profile.

• Therapies on the horizon that target both the immune system and neural systems show promise in efficacy for chronic itch in addition to an improved safety profile.

This box summarizes key points contained in the article.

Declaration of interest

G Yosipovitch is Scientific Board Member of Menlo, Trevi, Sanofi, Regeneron, Galderma, Pfizer, Novartis, Bayer, Kiniksa, and Eli Lilly. G Yosipovitch has received research support from Pfizer, Sun Pharma, Leo, Menlo, Novartis, Kiniksa. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.