Shawn G. Kwatra, MD, reported at the virtual annual meeting of the American Academy of Dermatology.
Dr. Shawn Kwatra
Dr. Kwatra, a dermatologist at Johns Hopkins University, Baltimore, where he heads a specialized pruritus clinic, presented a retrospective study of 16 such patients treated with inhaled butorphanol. All had been responsive to a minimum of four antipruritic medications.
This is one of the largest-ever reported series of patients treated with intranasal butorphanol as acute rescue therapy for intractable itch, and it provides a strong signal of efficacy, he said in an interview.
Indeed, 11 of the 16 patients reported marked improvement in their itch after introduction of short-term treatment with butorphanol nasal spray, 1 reported no improvement, and 4 were lost to follow-up.
Itch, Dermatology Life Quality Index (DLQI), and Beck Depression Inventory scores were formally measured prior to introduction of short-term inhaled butorphanol and again at follow-up appointments at 4-6 weeks. The mean self-reported itch numeric rating scale score improved from a mean of 9.8 out of a possible 10 at baseline to 4.6 at follow-up. The reduction in itch was accompanied by major improvements in quality of life: the mean DLQI score dropped from 20.2 to 10.8, while the Beck Depression Inventory score went from 22.1 – typically interpreted as an indicator of moderate depression – to 14.2.
Three patients reported insomnia and/or lightheadedness they attributed to inhaled butorphanol.
The patients with chronic refractory itch had a wide range of associated underlying diagnoses. These included primary sclerosing cholangitis, trigeminal trophic syndrome, brachioradial pruritus, neuropathic pruritus, prurigo nodularis, chronic idiopathic urticaria, chronic aquagenic pruritus, atopic dermatitis, and itch induced by programmed death–1 immune checkpoint inhibitor therapy. It will take large randomized, controlled trials to determine which of these types of chronic pruritus benefit most from intranasal butorphanol, according to Dr. Kwatra.
Since butorphanol is a narcotic analgesic ill-suited to applications other than as short-term acute rescue therapy, there is a pressing unmet need for new therapies specifically targeting chronic itch as a symptom, he added. Several promising agents are advancing through the drug development pipeline.
Dr. Kwatra reported having no financial conflicts regarding this study, conducted free of commercial support.