Lebrikizumab, Corticosteroid Regimen May Benefit Eczema After Dupilumab Discontinuation

Lisa A. Beck, MD

Credit: University of Rochester

Lebrikizumab plus topical corticosteroids (TCS) may be a beneficial alternative for patients with moderate to severe atopic dermatitis previously unresponsive to dupilumab, according to new research.¹

In late-breaking data from a post-hoc analysis presented at the Revolutionizing Atopic Dermatitis (RAD) 2023 Spring Conference in Washington, DC, this weekend, a team of US dermatology investigators reported that patients from the pivotal phase 3 ADhere clinical who previously failed to report eczema clearance with dupilumab were more than likely to achieve Eczema Area Severity Index (EASI) after a regimen of lebrikizumab plus TCS.

The findings highlights the evolving understanding of how systemic therapies—and in this particular case, a pair of agents that uniquely target the interleukin 13 (IL-13) pathway—vary in benefit for chronic inflammatory skin diseases.

Presented by study author Lisa A. Beck, MD, of the University of Rochester Medical Center, and funded by Dermira under Eli Lilly and Company, the new post-hoc analysis sought to evaluate lebrikizumab’s efficacy in the subset of ADhere trial participants with moderate to severe atopic dermatitis who reported prior dupilumab exposure.

The 16-week ADhere trial showed the novel IL-13 inhibitor’s efficacy in combination with TCS for treating adults and adolescents with atopic dermatitis versus placebo. While dupilumab is similarly indicated to treat moderate to severe atopic dermatitis, Beck and colleagues noted not all treated patients achieve and maintain clinically meaningful response with the fellow IL-13 inhibitor.

The team’s analysis included patients aged ≥12 to <18 years old with a ≥1-year atopic dermatitis. Further eligibility included baseline EASI ≥16, Investigators Global Assessment (IGA) score of ≥3, and body surface area (BSA) involvement of ≥10%. The final assessment included just 20 patients with prior dupilumab exposure. The most prevalent cause of dupilumab discontinuation was loss of or inadequate response (n = 10).

Investigators sought outcomes including IGA 0-1 after treatment, as well as ≥2-point improvement from baseline; EASI 75; and percentage of patients achieving a Pruritus Numerical Rating Scale (NRS) reduction of ≥4 points from baseline.

Mean patient age was 46.0 years old; only 1 patient was adolescent. Seven patients were female; 10 patients were White.

Six of 18 eligible patients receiving bi-weekly 250 mg lebrikizumab plus TCS achieved IGA 0 or 1 with a ≥2-point improvement after 16 weeks of treatment. Another 13 of 18 achieved EASI 75; 8 of 15 eligible patients achieved a ≥4-point improvement in Pruritus NRS.

Though the post-hoc analysis was limited by the small amount of eligible patients in the subpopulation, Beck and colleagues concluded patients with atopic dermatitis and a prior failed dupilumab regimen may respond better to lebrikizumab plus TCS.

References

1. ^{Gold LS, Gutermuth J, Adam D, Flohr C, et al. Lebrikizumab Providers Clinically Meaningful Improvements in Atopic Dermatitis in Patients Previously Treated with Dupilumab. Paper presented at: Paper presented at: Revolutionizing Atopic Dermatitis 2023 Spring Conference; April 29 – May 1, 2023; Washington, DC. Accessed April 30, 2023.}