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touchMDT Establishing treatment and care pathways for patients with prurigo nodularis: A patient-centric focus from multidisciplinary perspectives

Select a discussion in our hub to watch our multidisciplinary experts, including a patient advocate, share important perspectives on the need to establish patient-centric treatment and care pathways for the management of prurigo nodularis.

 Overview & Learning Objectives

Patient with prurigo nodularis
Dermatologists, psychodermatologist and patient advocate
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Burden of prurigo nodularis Dr Pereira, Ms Maganti, Prof. Bewley, Prof. Metz

Two dermatologists, a psychodermatologist and a patient advocate consider the clinical challenges that contribute to the overall burden of prurigo nodularis.

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Dermatologists and psychodermatologist
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Management of prurigo nodularis Prof. Metz, Dr Pereira, Prof. Bewley

Two dermatologists and a psychodermatologist discuss the latest developments in the treatment landscape for prurigo nodularis.

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Dermatologists, psychodermatologist and patient advocate
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Patient-centric care for prurigo nodularis Prof. Metz, Ms Maganti, Prof. Bewley, Dr Pereira

Two dermatologists, a psychodermatologist and a patient advocate share their views on why a holistic, multidisciplinary team approach is so important in establishing patient-centric treatment and care pathways for prurigo nodularis.

Watch Video
Dermatologists, psychodermatologist and patient advocate

Two dermatologists, a psychodermatologist and a patient advocate consider the clinical challenges that contribute to the overall burden of prurigo nodularis.

Expert Spotlight
Dr Manuel Pereira
Institute of Allergology (IFA), Charité – Universitätsmedizin Berlin, Germany
Ms Sailaja Maganti
Prurigo Nodularis International, London, UK
Prof. Anthony Bewley
Barts Health NHS Trust, London, UK
Prof. Martin Metz
Institute of Allergology (IFA), Charité – Universitätsmedizin Berlin, Germany

Two dermatologists, a psychodermatologist and a patient advocate share their perspectives on the burden associated with prurigo nodularis.
Listen on the Go

 Learn more Back to MDT Hub Time: 12:24
 
Dermatologists and psychodermatologist

Two dermatologists and a psychodermatologist discuss the latest developments in the treatment landscape for prurigo nodularis.
Expert Spotlight
Prof. Martin Metz
Institute of Allergology (IFA), Charité – Universitätsmedizin Berlin, Germany
Dr Manuel Pereira
Institute of Allergology (IFA), Charité – Universitätsmedizin Berlin, Germany
Prof. Anthony Bewley
Barts Health NHS Trust, London, UK

Two dermatologists and a psychodermatologist discuss the management of prurigo nodularis.
Listen on the Go

 Learn more Back to MDT Hub Time: 13:00
 
Dermatologists, psychodermatologist and patient advocate

Two dermatologists, a psychodermatologist and a patient advocate share their views on why a holistic, multidisciplinary team approach is so important in establishing patient-centric treatment and care pathways for prurigo nodularis.
Expert Spotlight
Prof. Martin Metz
Institute of Allergology (IFA), Charité – Universitätsmedizin Berlin, Germany
Ms Sailaja Maganti
Prurigo Nodularis International, London, UK
Prof. Anthony Bewley
Barts Health NHS Trust, London, UK
Dr Manuel Pereira
Institute of Allergology (IFA), Charité – Universitätsmedizin Berlin, Germany

Two dermatologists, a psychodermatologist and a patient advocate consider the ideal patient-centric care pathway for prurigo nodularis.
Listen on the Go

 Learn more Back to MDT Hub Time: 12:46
 
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Overview & Learning Objectives
Overview

In this activity, a multidisciplinary team (two dermatologists and a psychodermatologist) and a patient advocate share their perspectives on the burden and unmet clinical needs associated with prurigo nodularis (PN), the current and emerging treatment landscape for PN, and the importance of a holistic, multidisciplinary approach in establishing optimal treatment and care pathways for patients with PN.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of dermatologists, psychodermatologists, internal medicine specialists, nurse practitioners, physician assistants, advanced practice clinicians, managed care/pharmacy directors/pharmacists, and family practice/GPs/PCPs who may encounter and need to manage patients with prurigo nodularis.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Prof. Anthony Bewley discloses: Consulting or advisory board fees from AbbVie, Almirall, BMS, Eli Lilly, Galderma, Janssen, Leo Pharma, Novartis, Pfizer, Sanofi and UCB; Grants/research support from Janssen.

Prof. Martin Metz discloses: Speaker, consulting, advisory board or panel fees from Amgen (relationship ended), Celldex Therapeutics (relationship ended), Galderma and Sanofi-Aventis.

Dr Manuel Pereira discloses: Speaker, consulting, advisory board or panel fees from AbbVie, Beiersdorf, Eli Lilly, GA2LEN, Galderma, Menlo Therapeutics, Novartis, Sanofi, Trevi Therapeutics and Unna Academy.

Ms Sailaja Maganti discloses: Consulting fees from Galderma.

Content reviewer

Angela Hill, PharmD has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Christina Mackins-Crabtree has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu)

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Pharmacists

USF Health is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This knowledge-based program has been approved for 0.75 contact hours (0.075 CEUs). Universal Activity Number (UAN) is as follows: 0230-9999-24-001-H01-P.

Date of original release: 06 February 2024. Date credits expire: 06 February 2025.

If you have any questions regarding credit please contact cpdsupport@usf.edu

Learning Objectives

After watching this activity, participants should be better able to:

  • Define the burden of disease and unmet need for prurigo nodularis
  • Recall and apply the range of treatment and management options available for prurigo nodularis, including approved treatments, appropriately
  • Implement a holistic, multidisciplinary approach to care for prurigo nodularis, taking into account patient’s individual circumstances and needs
Faculty & Disclosures
Prof. Anthony Bewley

Barts Health NHS Trust, London, UK

Professor Anthony Bewley, BA (Hons), FRCP, is a consultant dermatologist at Barts Health NHS Trust, London, UK, and an honorary professor at Queen Mary College (University of London). read more

He is fully trained in general dermatology, with a special interest in psychodermatology (psycho-cutaneous medicine). He is the lead for commercial clinical trials research at the Barts Health Dermatology Department, and has published extensively in international peer-reviewed journals on a range of different areas within dermatology. Prof. Bewley was chair of Psychodermatology UK 2008–2020; president of the UK Dowling Dermatology Club 2019–2020 and honorary treasurer of the British Association of Dermatologists (2019–2022). He is the co-editor of Practical Psychodermatology and Psychodermatology in Clinical Practice. He is president of the European Society for Dermatology and Psychiatry

Prof. Anthony Bewley discloses: Consulting or advisory board fees from AbbVie, Almirall, BMS, Eli Lilly, Galderma, Janssen, Leo Pharma, Novartis, Pfizer, Sanofi and UCB; Grants/research support from Janssen.
Prof. Martin Metz

Institute of Allergology (IFA), Charité – Universitätsmedizin Berlin, Germany

Martin Metz, MD, is a professor of dermatology at the Institute of Allergology at the Charité – Universitätsmedizin Berlin, Germany, and the Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Department of Allergology and Immunology. read more

He received his medical education at the Free University of Berlin and the Humboldt University of Berlin. He specialized in dermatology at King’s College Hospital, London, UK, and the University of Mainz, Germany, and in experimental pathology at Beth Israel Deaconess Medical Centre and Harvard Medical School in Boston (1997–1998) and Stanford University (2004–2006) in the USA. He is board certified in dermatology and allergology, and is head of the specialty outpatient clinics for pruritus, head of translational research, and deputy head of clinical research at the Institute of Allergology, Charité – Universitätsmedizin Berlin. His main scientific areas of interest are mast cell biology, neuroimmunology, inflammation and innate immunity, with a major clinical and translational focus on pruritus and mast cell mediated diseases.

Prof. Martin Metz discloses: Speaker, consulting, advisory board or panel fees from Amgen (relationship ended), Celldex Therapeutics (relationship ended), Galderma and Sanofi-Aventis.
Dr Manuel Pereira

Institute of Allergology (IFA), Charité – Universitätsmedizin Berlin, Germany

Manuel P Pereira, MD, PhD, is dermatologist at the Institute of Allergology at the Charité – Universitätsmedizin Berlin, Germany, and the Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Department of Allergology and Immunology. read more

He received his medical education at the University of Porto, Portugal, and at Charité – Universitätsmedizin Berlin. He completed his training in dermatology at the University Hospital Münster, Germany. Additionally, he obtained a PhD from the Neuroscience Graduate School at the University of Copenhagen, Denmark. His main research interests include translational and clinical research in chronic itch, chronic prurigo and atopic dermatitis.

Dr Manuel Pereira discloses: Speaker, consulting, advisory board or panel fees from AbbVie, Beiersdorf, Eli Lilly, GA2LEN, Galderma, Menlo Therapeutics, Novartis, Sanofi, Trevi Therapeutics and Unna Academy.
Ms Sailaja Maganti

Prurigo Nodularis International, London, UK

Ms Sailaja Maganti is the founder of Prurigo Nodularis International (PNI), London, UK. read more

With almost 20 years’ lived experience of prurigo nodularis (PN), Sailaja leads the largest global support group for patients with PN. With almost 5,000 subscribers, she is currently establishing PNI as a formal charity and will assume the roles of chair and trustee.

Having endured a 9-year rollercoaster of a diagnosis journey, prurigo nodularis completely upended her life. This experience led Sailaja to become a passionate and outspoken advocate, determined to see those with a rare disease receive the care and dedicated treatments they all need and deserve, on par with patients of mainstream conditions.

Sailaja is able to leverage a deep and broad skill set gained from a lengthy career in investment and central banking to her advocacy work.

Ms Sailaja Maganti discloses: Consulting fees from Galderma.
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This activity is funded by:

An independent medical education grant from Sanofi and Regeneron Pharmaceuticals. This activity is jointly provided by USF Health and touchIME.

The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

This content is intended for healthcare professionals.

Date of original release: 06 February 2024. Date credits expire: 06 February 2025.

This content is intended for healthcare professionals only. Please confirm that you are a healthcare professional.

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Question 1/5
Your 30-year-old male patient is attending for his first visit following referral by a primary care physician for a 3-year history of chronic pruritus and significant sleep disturbance. During the clinical examination, you identify 10 PN lesions on his trunk. Which of these options would be your next step in addition to prescribing first-line treatment?

HIV, human immunodeficiency virus; PN, prurigo nodularis.
 Correct

Patients with PN can experience a high burden of disease that can significantly impact their quality of life and mental health. It is therefore important to assess the severity of their disease and requirement for mental health support at the initial visit.1

Malignancy screening is recommended if suspected during the physical examination; however, pruritus for >1 year in the absence of other systemic symptoms is unlikely to be related to malignancy.1 The IFSI guidelines recommend performing a biopsy in case of clinically atypical or refractory PN or clinical signs or symptoms of conditions that requires a biopsy for their diagnosis, which does not apply to this patient.2 HIV testing is only recommended as an additional test to consider based on findings from the clinical examination and patient risk factors.1

Abbreviations
HIV, human immunodeficiency virus; IFSI, International Forum for the Study of Itch; PN, prurigo nodularis.

References
1. Elmariah S, et al. J Am Acad Dermatol. 2021;84:747–60.
2. Ständer S, et al. Itch. 2020;5:e42.

Question 2/5
When making a diagnosis of PN, which of the following is the most important to consider?

PN, prurigo nodularis.
 Correct

As PN is a diagnostic challenge, it is imperative to discern any underlying causes, associated comorbidities and potential mimickers through focused and pertinent laboratory, imaging and histological workup.1 The diagnostic workup should begin with a clinical examination that includes a complete review of systems, including the consideration of potential systemic disease. A dermatological examination should be carried out to assess the extent of prurigo nodularis (number and firmness of lesions).2 It is also important to be comprehensive in obtaining clinical history surrounding the patient’s pruritus and the subsequent impact on the patient’s quality of life.1

Abbreviation
PN, prurigo nodularis.

References
1. Williams KA, et al. Expert Rev Clin Pharmacol. 2021;14:67–77.
2. Elmariah S, et al. J Am Acad Dermatol. 2021;84:747–60.

Question 3/5
You have a 45-year-old female patient with moderate-to-severe PN. According to the stepwise approach in the 2020 IFSI guidelines, you decide to start treatment at step 3. Which of the following treatments would you be considering?

IFSI, International Forum for the Study of Itch; PN, prurigo nodularis; UV, ultraviolet.
 Correct

According to the 2020 IFSI guidelines, a stepwise approach to treatment should be taken. Therapies in step 3 of the treatment ladder are gabapentin, pregabalin, cyclosporine, methotrexate and antidepressants. Therapy should be individualized and the order of treatments is not mandatory; therapies can be combined and steps can be skipped if necessary.

Abbreviation
IFSI, International Forum for the Study of Itch.

Reference
Ständer S, et al. Itch. 2020;5:e42.

Question 4/5
Your 48-year-old female patient was diagnosed with PN over 2 years ago. She has over 50 PN lesions, and has experienced limited improvement with topical corticosteroids, UV phototherapy and gabapentin. Her quality of life remains significantly impaired and her pruritus severity has not improved. Assuming all options are available in your region, what treatment would you prescribe next?

PN, prurigo nodularis; UV, ultraviolet.
 Correct

H1-antihistamines, topical calcineurin inhibitors and intralesional corticosteroids are all in steps 1 and 2 of the treatment ladder recommended by IFSI.1 Dupilumab has recently been approved by the FDA and EMA as the first and only systemic therapy for the treatment of adults with PN, based on data from the PRIME and PRIME2 clinical trials.2–4

Abbreviations
EMA, European Medicines Agency; FDA, US Food and Drug Administration; IFSI, International Forum for the Study of Itch; PN, prurigo nodularis.

References
1. Ständer S, et al. Itch. 2020;5:e42.
2. FDA. Dupilumab PI. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2022/761055s044lbl.pdf (accessed January 2024).
3. EMA. Dupilumab SPC. Available at: www.ema.europa.eu/en/documents/product-information/dupixent-epar-product-information_en.pdf (accessed January 2024).
Yosipovitch G, et al. Nat Med. 2023;29:1180–90

Question 5/5
Which of the following statements is true with regard to the treatment approach for patients with newly diagnosed PN?

PN, prurigo nodularis.
 Correct

An effective treatment approach for PN should be based on clinical judgement and tailored to the individual needs of the patient, considering clinical presentation, comorbidities and response to prior treatments, and should include therapies targeting both neural and immunological mechanisms of pruritus.

Abbreviation
PN, prurigo nodularis.

Reference
Elmariah S, et al. J Am Acad Dermatol. 2021;84:747–60.

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