Intranasal Butorphanol Effectively Reduces Pruritus

The following article is part of coverage from the American Academy of Dermatology’s Annual Meeting (AAD 2020). Because of concerns regarding the coronavirus disease 2019 (COVID-19) pandemic, all AAD 2020 sessions and presentations were transitioned to a virtual format. While live events will not proceed as planned, readers can click here to view more news related to research presented during the AAD VMX 2020 virtual experience.

Intranasal butorphanol was effective in reducing itch for a series of patients with chronic pruritus, according to study results presented at the American Academy of Dermatology’s Virtual Meeting Experience (AAD VMX) 2020, held online from June 12 to 14, 2020.

The study comprised a retrospective review of 16 adult patients with chronic pruritus who presented to the Johns Hopkins Department of Dermatology from 2015 to 2019. All patients had experienced treatment failure with ≥4 therapies and had a trial of butorphanol 10 mg/mL inhaler. The researchers examined patient-reported change in itch severity after treatment with intranasal butorphanol as measured by the pre- and post-treatment pruritus numerical rating scale (NRS) scores and the mean Dermatology Life Quality Index (DLQI) and Beck Depression Inventory scores.

Approximately 69% (n=11) of patients reported improvement in symptoms after the start of butorphanol treatment, whereas 6% (n=1) reported no improvement and 25% (n=4) were lost to follow up. Mean NRS score decreased from 9.8 before treatment to 4.6 after treatment (P <.0001). In addition, the Mean Dermatology Life Quality Index score improved from 20.2 before treatment to 10.8 after treatment with butorphanol (P =.004). The mean Beck’s Depression Inventory score also significantly improved from before to after treatment (22.1 to 14.2, respectively; P =.005).

Symptom improvement with intranasal butorphanol was observed in patients with chronic aquagenic pruritus, brachioradial pruritus, chronic idiopathic urticaria, neuropathic pruritus, PD1-inhibitor induced pruritus, primary sclerosing cholangitis, trigeminal trophic syndrome, prurigo nodularis, prurigo mitis, and atopic dermatitis. Approximately 19% (n=3) of patients reported an adverse event related to treatment. The most frequent adverse events included somnolence (49%), dizziness (23%), nasal congestion (13%), insomnia (11%), and nausea and/or vomiting (8%).

Limitations of this study were the open-label design and the small number of patients included in the study sample.

The researchers noted that the improvement in itch symptoms associated with butorphanol “had a positive impact on patient quality of life, underscoring the need for more therapies specifically targeting itch as a symptom.”

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Khanna R, Kwon CD, Patel SP, et al. Intranasal butorphanol as a rescue therapy for the treatment of intractable pruritus. Presented at: AAD VMX 2020; June 12-14, 2020. Abstract/Poster 17132.