Effectiveness of Aprepitant in Patients with Refractory Pruritus Secondary to Sézary Syndrome

Background: In advanced stages, patients with Sezary Syndrome (SS) commonly report an ill-defined, severe and diffuse pruritus. Recently, it has been reported that Aprepitant, an oral neurokinin-1-receptor (NK1) antagonist, may have an important role in relief of refractory pruritus in patients with SS. Material and methods: A prospective study which included four patients with SS, in whom pruritus is the main symptom, was performed. Our purpose was to assess efficacy of Aprepitant for treatment of refractory pruritus, secondary to SS. Patients were treated with Aprepitant 80 mg/d during 10 days and then the dosage was reduced to alternate days. The length of treatment ranged between 4 and 23 weeks. Improvement was assessed by the Dermatology Life Quality Index (DLQI) questionnaire, which ranges from 0 to 30, with high scores indicating worse outcome and by Visual Analogue Scale (VAS) which varies from 0 to 10, with higher scores meaning severe pruritus. Results: Prior to treatment, subjects had severe pruritus with mean DLQI score of 21.5 (SD ± 2.4) and mean VAS score of 9.0 (SD ± 0.8). At the end of the treatment, a statistically significant reduction in both indexes (p<0.05) was evident. In all patients, an improvement of pruritus was rapidly observed after the first week of therapy. No side effects were reported. Conclusion: The study confirms the effectiveness and safety of Aprepitant as an antipruritic agent in patients with refractory pruritus secondary to SS.