Nemolizumab and Hyponatremia
Hyponatremia is not a recognized adverse effect of nemolizumab based on available clinical trial data. The most common adverse events reported with nemolizumab are nasopharyngitis, upper respiratory tract infection, COVID-19, headache, and atopic dermatitis exacerbation 1, 2, 3, 4.
Safety Profile of Nemolizumab
Across multiple clinical trials spanning up to 200 weeks of treatment, hyponatremia has not been identified as a treatment-emergent adverse event associated with nemolizumab 2, 3, 4. The safety profile is well-characterized:
- Most common adverse events (≥5%): COVID-19 (19.6%), nasopharyngitis (19.5%), atopic dermatitis (18.1%), upper respiratory tract infection (12.7%), headache (6.5%), and asthma (5.5%) 4
- Severity: The majority (92.6%) of treatment-emergent adverse events were mild to moderate, with only 22.1% considered related to nemolizumab 4
- Long-term safety: Through 104 weeks of continuous treatment, nemolizumab was well-tolerated with no new safety concerns identified 4
Documented Adverse Events
The clinical trial data spanning phase 2 and phase 3 studies consistently report the following adverse event profile:
- Dermatologic: Exacerbation of atopic dermatitis, erythema, and in one case report, bullous pemphigoid 5
- Hematologic: Eosinophilia 5
- Infectious: Upper respiratory tract infections and nasopharyngitis 1, 2, 3
- General: Headache 4
Clinical Implications
If hyponatremia develops in a patient receiving nemolizumab, alternative etiologies should be investigated rather than attributing it to the medication 6. Standard hyponatremia workup should include:
- Assessment of volume status (hypovolemic, euvolemic, or hypervolemic) 6
- Serum and urine osmolality, urine sodium concentration 6
- Evaluation for SIADH, cerebral salt wasting, or other causes 6
- Review of concomitant medications that may cause hyponatremia 6
Management Approach if Hyponatremia Occurs
Should hyponatremia develop during nemolizumab therapy, management should follow standard hyponatremia protocols based on severity and volume status 6:
- For severe symptomatic hyponatremia: Administer 3% hypertonic saline with target correction of 6 mmol/L over 6 hours, not exceeding 8 mmol/L in 24 hours 6
- For euvolemic hyponatremia (SIADH): Implement fluid restriction to 1 L/day as first-line treatment 6
- For hypovolemic hyponatremia: Provide isotonic saline for volume repletion 6
- For hypervolemic hyponatremia: Implement fluid restriction to 1-1.5 L/day 6
Nemolizumab continuation would not require modification unless hyponatremia is definitively linked to the drug through rechallenge or other compelling evidence, which has not been demonstrated in the literature 1, 2, 3, 4.