Nemolizumab for prurigo nodularis: Insights from the Olympia study

Prurigo nodularis (PN) is a chronic, highly pruritic skin disease characterised by multiple hyperkeratotic nodules and intense, treatment-resistant itch. It represents a major therapeutic challenge, as options remain limited. Currently, dupilumab is the only biologic approved for PN, but its use is restricted to patients with more than 100 nodules, and clinical responses are often incomplete.

Nemolizumab, a monoclonal antibody directed against the IL-31 receptor, represents a novel therapeutic approach. IL-31, frequently referred to as the “itch cytokine,” plays a central role in pruritus pathophysiology, making it a promising target in PN. 

Dr Tom Hillary, dermatologist from UZ Leuven, was one of the PI of the Olympia study, evaluating the efficacy and safety of nemolizumab compared with placebo during the induction phase. Clinical outcomes were striking. Some patients reported symptomatic relief as early as the first night after initiating therapy, with progressive improvement over the following weeks. By week eight, a substantial proportion of patients achieved complete resolution of pruritus, accompanied by notable reductions in lesion burden. These early results were maintained during long-term extension, where patients have now received nemolizumab for several years. Sustained efficacy and a favourable safety profile have been observed, confirming its potential as a durable treatment option for PN.