Correspondence
Aprepitant as an Antipruritic Agent?
N Engl J Med 2009; 361:1415-1416October 1, 2009
- Article
To the Editor:
The Sézary syndrome is a leukemic, cutaneous, epidermotropic T-cell lymphoma. Pruritus, insomnia, and depression impair the quality of life and can lead to suicide.1 Substance P is a key mediator of pruritus.2 An increase in the expression of its receptor, neurokinin-1, has been reported on keratinocytes in pruritic skin diseases.3 Aprepitant is an oral neurokinin-1–receptor antagonist.4 It is widely used as an antiemetic agent in chemotherapy-induced nausea and vomiting.5 However, its action suggests a potential reduction in substance P–induced pruritus, even though pruritus is considered a rare side effect of this drug.
We report on three patients with the Sézary syndrome in whom pruritus was the main symptom and could not be controlled with conventional therapy. All three patients presented with erythroderma and were about to undergo or had recently begun extracorporeal photochemotherapy. They were hospitalized because of pruritus and pruritus-related insomnia and depression, despite intermittent application of corticosteroid ointment. An evaluation of pruritus by means of a visual-analogue scale, in which a score of 0 indicates no pruritus and a score of 10 indicates the worst pruritus imaginable, resulted in scores of 7, 8, and 9 in the three patients, respectively. Evaluation of quality of life with the Dermatology Life Quality Index (DLQI) questionnaire (range, 0 to 30; higher scores indicates worse outcomes) resulted in scores of 22 in Patient 1 and 17 in Patient 2. The DLQI score was not estimated in the third patient, who was elderly and living in an institution. The day after we started administering oral aprepitant (80 mg daily), the scores on the visual-analogue scale fell to 2, 3, and 2, respectively. One week later, the visual-analogue scale scores were the same and the DLQI score was 8 in Patient 1 and 4 in Patient 2. For Patient 3, the institution staff reported important lessening of the pruritus and improvement in sleep. All three patients reported diminished insomnia and better quality of sleep. No effect was seen on erythroderma.
When aprepitant was initiated, the patients were using only emollient creams and no corticosteroid ointment. Their regular treatment was not modified. These three cases suggest that aprepitant could be effective against pruritus associated with the Sézary syndrome.
5 ReferencesArnaud Duval, M.D.
Louis Dubertret, M.D., Ph.D.
Hôpital Saint-Louis, Paris, France
arnaud.duval@sls. aphp. fr 1
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Full Text | Web of Science | Medline
- Citing Articles (14)
Citing Articles
1
Tiago Torres, Iolanda Fernandes, Manuela Selores, Rosário Alves, Margarida Lima. (2012) Aprepitant: Evidence of its effectiveness in patients with refractory pruritus continues. Journal of the American Academy of Dermatology 66:1, e14-e15
CrossRef2
Kristen Ahern, Elaine S. Gilmore, Brian Poligone. (2012) Pruritus in cutaneous T-cell lymphoma: A review. Journal of the American Academy of Dermatology
CrossRef3
Ferda Cevikbas, Martin Steinhoff, Akihiko Ikoma. (2011) Role of Spinal Neurotransmitter Receptors in Itch: New Insights into Therapies and Drug Development. CNS Neuroscience & Therapeutics 17:6, 742-749
CrossRef4
Barbara Geusens, Ilse Mollet, Chris D. Anderson, Sarah Terras, Michael S. Roberts, Jo Lambert. 2011. Changes in Skin Immunity with Age and Disease. , 215-258.
CrossRef5
H.L. Tey, G. Yosipovitch. (2011) Targeted treatment of pruritus: a look into the future. British Journal of Dermatology 165:1, 5-17
CrossRef6
Akihiko Ikoma, Ferda Cevikbas, Cordula Kempkes, Martin Steinhoff. (2011) Anatomy and Neurophysiology of Pruritus. Seminars in Cutaneous Medicine and Surgery 30:2, 64-70
CrossRef7
Herbert C. Chiang, Victor Huang, Lynn A. Cornelius. (2011) Cancer and Itch. Seminars in Cutaneous Medicine and Surgery 30:2, 107-112
CrossRef8
N. Booken, M. Heck, J.P. Nicolay, C.D. Klemke, S. Goerdt, J. Utikal. (2011) Oral aprepitant in the therapy of refractory pruritus in erythrodermic cutaneous T-cell lymphoma. British Journal of Dermatologyno-no
CrossRef9
M Metz, S Ständer. (2010) Chronic pruritus - pathogenesis, clinical aspects and treatment. Journal of the European Academy of Dermatology and Venereology 24:11, 1249-1260
CrossRef10
Gil Yosipovitch. (2010) Chronic pruritus: a paraneoplastic sign. Dermatologic Therapy 23:6, 590-596
CrossRef11
Andreas E. Kremer, Job J.W.W. Martens, Wim Kulik, Franziska Ruëff, Edith M.M. Kuiper, Henk R. van Buuren, Karel J. van Erpecum, Jurate Kondrackiene, Jesus Prieto, Christian Rust, Victoria L. Geenes, Catherine Williamson, Wouter H. Moolenaar, Ulrich Beuers, Ronald P.J. Oude Elferink. (2010) Lysophosphatidic Acid Is a Potential Mediator of Cholestatic Pruritus. Gastroenterology 139:3, 1008-1018.e1
CrossRef12
Bruno Vincenzi, Maria Elisabetta Fratto, Daniele Santini, Giuseppe Tonini. (2010) Aprepitant against pruritus in patients with solid tumours. Supportive Care in Cancer 18:9, 1229-1230
CrossRef13
Vincenzi, Bruno, Tonini, Giuseppe, Santini, Daniele, . (2010) Aprepitant for Erlotinib-Induced Pruritus. New England Journal of Medicine 363:4, 397-398
Full Text14
Malcolm W. Greaves. (2010) Pathogenesis and Treatment of Pruritus. Current Allergy and Asthma Reports 10:4, 236-242
CrossRef
