Nalfurafine hydrochloride to treat pruritus: a review
Shigeki InuiDepartment of Regenerative Dermatology, Osaka University Graduate School of Medicine, Osaka, JapanAbstract: Uremic pruritus has a great negative influence on quality of life in hemodialysis (HD) patients and, importantly, negatively affects mortality risk. Recently, nalfurafine hydrochlo...
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doaj-df7ca19f71d2401483920cd282f96f332020-11-24T20:57:21ZengDove Medical PressClinical, Cosmetic and Investigational Dermatology1178-70152015-05-012015default24925521675Nalfurafine hydrochloride to treat pruritus: a reviewInui SShigeki InuiDepartment of Regenerative Dermatology, Osaka University Graduate School of Medicine, Osaka, JapanAbstract: Uremic pruritus has a great negative influence on quality of life in hemodialysis (HD) patients and, importantly, negatively affects mortality risk. Recently, nalfurafine hydrochloride, an opioid κ-selective agonist, has been officially approved for resistant pruritus in HD patients on the basis of a well-evidenced clinical trial in Japan. From clinical observation, it has been suggested that the upper neuron system plays a role in its pathogenesis. According to previous experimental results, using mice injected with opioids, dynorphin suppresses itch through binding κ-opioid receptors, suggesting that κ-opioid opioid receptor agonists act as potential therapeutic reagents for pruritus in HD patients. In Japan, a large-scale placebo-controlled study was performed to examine the efficacy and safety of oral nalfurafine hydrochloride for intractable pruritus in 337 HD patients. Two daily doses of 2.5 or 5 µg nalfurafine or placebo were orally administered for 2 weeks, and clinical responses were analyzed. The results showed that the mean decrease in the visual analog scale for pruritus from baseline was 22 mm in the 5 µg nalfurafine hydrochloride group (n=114) and 23 mm in the 2.5 µg group (n=112). These reductions were statistically significant compared with 13 mm, which is the mean decrease of visual analog scale in the placebo group (n=111), demonstrating that nalfurafine is an effective and safe drug for uremic pruritus in HD patients. Moreover, another open-label trial (n=145) examining the long-term effect of 5 µg oral nalfurafine revealed the maintenance of the antipruritic effect of nalfurafine for 52 weeks. In addition, on the basis of recent data showing κ-opioid receptor expression in the epidermis of atopic dermatitis and psoriasis, nalfurafine hydrochloride also can be potentially used for these two skin diseases.Keywords: nalfurafine hydrochloride, uremic pruritus, opioid κ-selective agonist, hemodialysis http://www.dovepress.com/nalfurafine-hydrochloride-to-treat-pruritus-a-review-peer-reviewed-article-CCID |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Inui S |
spellingShingle |
Inui S Nalfurafine hydrochloride to treat pruritus: a review Clinical, Cosmetic and Investigational Dermatology |
author_facet |
Inui S |
author_sort |
Inui S |
title |
Nalfurafine hydrochloride to treat pruritus: a review |
title_short |
Nalfurafine hydrochloride to treat pruritus: a review |
title_full |
Nalfurafine hydrochloride to treat pruritus: a review |
title_fullStr |
Nalfurafine hydrochloride to treat pruritus: a review |
title_full_unstemmed |
Nalfurafine hydrochloride to treat pruritus: a review |
title_sort |
nalfurafine hydrochloride to treat pruritus: a review |
publisher |
Dove Medical Press |
series |
Clinical, Cosmetic and Investigational Dermatology |
issn |
1178-7015 |
publishDate |
2015-05-01 |
description |
Shigeki InuiDepartment of Regenerative Dermatology, Osaka University Graduate School of Medicine, Osaka, JapanAbstract: Uremic pruritus has a great negative influence on quality of life in hemodialysis (HD) patients and, importantly, negatively affects mortality risk. Recently, nalfurafine hydrochloride, an opioid κ-selective agonist, has been officially approved for resistant pruritus in HD patients on the basis of a well-evidenced clinical trial in Japan. From clinical observation, it has been suggested that the upper neuron system plays a role in its pathogenesis. According to previous experimental results, using mice injected with opioids, dynorphin suppresses itch through binding κ-opioid receptors, suggesting that κ-opioid opioid receptor agonists act as potential therapeutic reagents for pruritus in HD patients. In Japan, a large-scale placebo-controlled study was performed to examine the efficacy and safety of oral nalfurafine hydrochloride for intractable pruritus in 337 HD patients. Two daily doses of 2.5 or 5 µg nalfurafine or placebo were orally administered for 2 weeks, and clinical responses were analyzed. The results showed that the mean decrease in the visual analog scale for pruritus from baseline was 22 mm in the 5 µg nalfurafine hydrochloride group (n=114) and 23 mm in the 2.5 µg group (n=112). These reductions were statistically significant compared with 13 mm, which is the mean decrease of visual analog scale in the placebo group (n=111), demonstrating that nalfurafine is an effective and safe drug for uremic pruritus in HD patients. Moreover, another open-label trial (n=145) examining the long-term effect of 5 µg oral nalfurafine revealed the maintenance of the antipruritic effect of nalfurafine for 52 weeks. In addition, on the basis of recent data showing κ-opioid receptor expression in the epidermis of atopic dermatitis and psoriasis, nalfurafine hydrochloride also can be potentially used for these two skin diseases.Keywords: nalfurafine hydrochloride, uremic pruritus, opioid κ-selective agonist, hemodialysis |
url |
http://www.dovepress.com/nalfurafine-hydrochloride-to-treat-pruritus-a-review-peer-reviewed-article-CCID |
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