Intranasal Butorphanol May be a Treatment Option for Pruritus

Butorphanol is FDA-approved to treat migraine headaches, musculoskeletal pain, and postoperative pain. Researchers assessed whether intranasal butorphanol could be used as rescue therapy for patients with chronic, refractory pruritis and observed its efficacy in treating intractable itch associated with dermatologic, systemic, and neurologic conditions. The results of the study were published as part of the American Academy of Dermatology Virtual Meeting Experience 2020.

Researchers conducted a retrospective review of adult patients who presented to the Johns Hopkins Department of Dermatology between June 2015 and July 2019 with a diagnosis of chronic pruritus. Patients had failed at least four therapeutics and were included in a trial of butorphanol 10 mg/mL inhaler. Pre- and post-treatment, patients reported change in symptoms via pruritus numerical rating scale (NRS) scores, Dermatology Life Quality Index (DLQI), and Beck Depression Inventory scores.

The study included 16 patients; 12 (75%) were female and seven (44%) were white. Mean age was 60.63 years, and the most common diagnosis was concomitant atopic dermatitis (AD; n=5; 31%).

Most patients (n=11; 69%) reported symptom improvement after treatment with intranasal butorphanol. The mean itch NRS score decreased from 9.8 at baseline to 4.6 after treatment (P<0.0001). Mean DLQI score significantly increased from 20.2 to 10.8 (P=0.004) and mean Beck’s Depression Inventory score improved from 22.1 to 14.2 (P=0.005).

The researchers reported that patients with the following itch-related diagnoses saw improvement in symptoms: 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 AD. Three patients (19%) reported treatment-related adverse events, including insomnia and lightheadedness.

“Improvement in itch symptoms had a positive impact on patient quality of life, underscoring the need for more therapies specifically targeting itch as a symptom,” the researchers concluded.

The study is limited by its small patient population and open-label design. The researchers noted the need for large-scale randomized, controlled trials to assess the safety and efficacy of intranasal butorphanol and to determine which types of chronic pruritus would benefit most from this treatment.

Khanna R, Kwon CD, Patel SP, et al. Intranasal butorphanol as a rescue therapy for the treatment of intractable pruritus. Presented during the AAD Virtual Meeting Experience 2020, June 12-14, 2020.