A new case report published in Cureus examines the use of nemolizumab, an anti-IL-31 receptor monoclonal antibody, as a possible treatment option for indolent systemic mastocytosis (SM) when conventional treatments fail or when other targeted therapies aren’t suitable.
The report describes the case of a 62-year-old woman with an 11-year history of indolent SM marked by recurrent symptoms such as flushing, pruritus (itching), urticaria (hives) and gastrointestinal upset.
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The woman’s symptoms, particularly intense pruritus and chronic hives, did not respond to standard therapies, including topical corticosteroids, hydroxyzine, montelukast, omalizumab and dupilumab. The patient declined avapritinib, a targeted KIT inhibitor that’s FDA-approved for the treatment of indolent SM, due to a previous stroke.
Doctors started her on nemolizumab, which has been shown in previous studies to be effective in reducing intensely itchy skin in other conditions like atopic dermatitis. Following an initial 60 mg dose and subsequent 30 mg doses every four weeks, the patient achieved complete resolution of pruritus after 12 doses.
Researchers suggest that by targeting interleukin-31 signaling — a pathway closely linked to chronic itch — nemolizumab may offer a novel way to alleviate one of the most bothersome symptoms of indolent SM. They note this is the first reported case of the use of the medication to treat the condition.
The authors say more studies are needed to validate these findings in larger cohorts and controlled clinical trials, particularly for patients who cannot tolerate or access other targeted agents.
“This report highlights the potential of nemolizumab as an effective treatment option for refractory ISM,” they wrote. “Further research is needed to establish the optimal dosage, ideal patient populations, and the long-term efficacy and safety of nemolizumab for ISM.”
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