Christophe Piketty, MD, PhD: The Role of Nemolizumab in Addressing Unmet Needs of Patients With AD and PN

Dermatology Times recently spoke with Christophe Piketty, MD, PhD, a dermatologist and the global program head at Galderma R&D, to discuss the recent regional approvals for nemolizumab (Nemluvio), including approvals in the European Union, UK, and Switzerland.^1-2

Piketty shared insights into the unmet needs of patients with atopic dermatitis (AD) and prurigo nodularis (PN) and delved into the significance of these approvals in supporting this underserved patient population.

The Burden of Atopic Dermatitis and Prurigo Nodularis

Patients with AD and PN often experience debilitating symptoms that go far beyond visible skin lesions.

"Even if there are already some drugs approved for both atopic dermatitis and prurigo nodularis, we know that a lot of patients are still not disease controlled or inadequately responding to those conditions," Piketty said.

These patients frequently struggle with high symptom burdens such as itch, sleep disturbance, and poor quality of life associated with these symptoms, making effective treatment options essential.

The Limitations of Current Therapies

Currently, several treatments are available for AD and PN, including biologics and JAK inhibitors. While these treatments can be effective, Piketty noted he remains unconvinced that switching between biologics targeting the same pathway will offer significant improvements for patients who are not responding adequately.

A New Hope for First-Line Treatment

With the introduction of nemolizumab, Piketty believes there could be a significant shift in treatment paradigms. Based on the encouraging results of the phase 3 clinical trials, which demonstrate efficacy on both skin lesions and symptoms such as itch and sleep disturbances, nemolizumab may be positioned as a first-line treatment for both AD and PN.

"In patients with high burden of symptoms, I would say probably Nemluviowill be a very good choice as a first line for the treatment of AD and PN," he noted.

Safety Concerns with Long-Term Treatment

While the efficacy of biologics and JAK inhibitors in treating AD is well-documented, safety concerns—especially in long-term use—remain a critical issue. This is especially relevant for patients with PN, who are often older (50 years and above). Piketty noted that JAK inhibitors, in particular, are associated with risks such as MACEs, thrombosis, and embolism, making them a less favorable option for elderly patients.

In contrast, nemolizumab’s safety profile, alongside its efficacy, makes it a promising option for patients in need of long-term management.

"For AD, there is clearly still room for new drugs, and coming with a new target is definitely a good therapeutic option for patients with AD," he said.

The Unmet Need in Prurigo Nodularis

Piketty highlighted that PN represents a major unmet medical need in dermatology. Since 2022, the FDA has approved dupilumab for PN, but the need for further therapeutic options is undeniable. The expert emphasized that nemolizumab could be a game-changer for patients with PN, citing its robust clinical development plan, which includes a phase 3 program with more than 500 patients—a program that is now the largest of its kind.

The phase 3 trials have demonstrated "quick onset of action on itch" and a "very high level of efficacy on lesions," which could significantly improve the lives of those suffering from PN. Furthermore, the long-term extension (LTE) studies show that nemolizumab's efficacy continues to improve over time.

"At the end of the first year of LTE, we have reached a high proportion of patients responding to Nemluvio on both signs and symptoms," Piketty shared.

Given the strong data from the clinical trials, Piketty is confident in the potential of nemolizumab to serve as a key therapeutic option for both AD and PN.

References

1. Galderma’s Nemluvio (nemolizumab) approved in the European Union for moderate-to-severe atopic dermatitis and prurigo nodularis. News release. February 14, 2025. Accessed February 25, 2025. https://www.galderma.com/news/galdermas-nemluvior-nemolizumab-approved-european-union-moderate-severe-atopic-dermatitis-and
2. Galderma’s Nemluvio (nemolizumab) granted marketing authorization in the United Kingdom and Switzerland for moderate-to-severe atopic dermatitis and prurigo nodularis. News release. February 18, 2025. Accessed February 25, 2025. https://www.galderma.com/news/galdermas-nemluvior-nemolizumab-granted-marketing-authorization-united-kingdom-and-0