Future Perspectives: New and Modern Therapies

Abstract

There is an urgent need for new, potent treatments options for all forms of chronic pruritus. Clinical and experimental research has identified many of the potential causes and mechanisms of pruritus within the last decade. The results of said research have, for example, determined the novel mediators causing inflammatory dermatoses and uremic and cholestatic pruritus in humans, thus allowing them to be validated as therapy targets. Intestinal ileal bile acid transporter receptors are a factor currently under investigation for cholestatic pruritus, while it is suspected that kappa-opioid receptors play a role in nephrogenic pruritus. Atopic dermatitis might also, according to research, be motivated by factors such as substance P and interleukins-31, -4 and -13. Ongoing investigational efforts prove favorable due to the initiation of new clinical trials and advancements in the pharmacological sector, but certain barriers, such as the lack of novel drugs, remain to be overcome. Recruiting patients for participation in studies is also complex. Many potential candidates are often exempt as a consequence of comorbidities and comedications. Because of subjective patient-reported endpoints, outcome analyses are also complicated. Furthermore, there is seldom consensus on the very clinical trial designs that require extensive basic work. There is still a need for the development of drugs for specific target populations and many pruritic diseases, for example, in children. Despite these hurdles, there is still much to be positive about. There are currently more clinical trials investigating chronic pruritus than ever before, and major changes in the realm of possibilities for understanding and treating pruritus are inevitable.