Lebrikizumab Shown to Have Comparable Efficacy to Dupilumab for Eczema

Aaron M. Drucker, MD

Credit: University of Toronto

Lebrikizumab is similar in efficacy to dupilumab for short-term treatment of adult patients with atopic dermatitis, according to new findings, allowing dermatologists and patients to make more comparisons as a means of informing treatment decisions.¹

These conclusions were the result of duplicate and random-effects bayesian network meta-analyses. This new research was led by Aaron M. Drucker, MD, from the division of dermatology at the University of Toronto department of medicine in Ontario, Canada.

Drucker and colleagues sought to compare the most recently US Food and Drug Administration (FDA)-approved biologic for eczema, lebrikizumab, with other systemic options.²

“Lebrikizumab has only been evaluated in placebo-controlled trials, so direct comparisons with other approved treatments cannot be made using existing clinical trials alone,” Drucker et al. wrote. “This update to our living systematic review and (network meta-analysis) compares the efficacy and safety of systemic immunomodulatory treatments for atopic dermatitis, including lebrikizumab.”¹

Background and Design

The investigators implemented a substantial search of several different databases for their analysis, with those included being ClinicalTrials.gov, the Latin American and Caribbean Health Science Information database, MEDLINE, the Cochrane Central Register of Controlled Trials, Embase, the Global Resource of Eczema Trials database, and the International Clinical Trials Registry Platform of the World Health Organization. Their search was updated every 4 months.

In this update, the research team looked at studies from the point of their inception until November 2023. Extraction of data was done by the team in duplicate, with the utilization of random-effects Bayesian network meta-analyses designed to process this information.

Minimal important differences were employed by the investigators to look at any significant distinctions between medications, with the investigators evaluating the certainty of the evidence through the use of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

The research team’s updated research was carried out from December 2023 - February 2024, with efficacy outcomes including the Patient-Oriented Eczema Measure (POEM), the Eczema Area and Severity Index (EASI), the Dermatology Life Quality Index (DLQI), and the Peak Pruritus Numeric Rating Scales (PP-NRS). The team made comparisons with mean differences (MD) as well as 95% credible intervals (CrI).

The outcomes related to safety which the investigators assessed included serious adverse events as well as withdrawals resulting from reports of adverse events (AEs). The team also evaluated the proportion of participating subjects reporting success on their Investigator Global Assessment (IGA) score and those reporting improvements of 50%, 75%, and 90% in their EASI scores (EASI-50, -75, -90) and those, using odds ratios with 95% CrI for comparisons.

Findings

Notably, the investigators found that there had been no major changes in subjects’ POEM (MD, −1.1; 95% CrI −2.5 to 0.2; moderate certainty), EASI (MD, −2.0; 95% CrI, −4.5 to 0.3; moderate certainty), or PP-NRS (MD, 0.1; 95% CrI −0.4, 0.6; high certainty), or DLQI scores (MD, −0.2; 95% CrI −2.1 to 1.6; moderate certainty) associated with lebrikizumab versus dupilumab therapy. Overall, there had been a total of 98 eligible trials noted by the research team, with a total of 24,707 subjects involved.

Dupilumab was, however, noted by the research team as showing higher odds of efficacy in binary outcomes versus lebrikizumab. Nevertheless, the conclusion reached by the team was that dupilumab and lebrikizumab had comparable efficacy results.

Other approved systemic therapies’ relative efficacy was reported by the team to have remained consistent with prior updates of this ongoing study.

The investigators noted that higher-dose abrocitinib and upadacitinib had been shown to have the highest relative efficacy numerically. In terms of safety findings, the lower AE rates were found to have hindered useful comparisons.

“The findings of this update to a living systematic review and NMA support lebrikizumab as another effective biologic medication for treating atopic dermatitis,” the investigators wrote. “Although binary efficacy outcomes favored dupilumab, the differences in efficacy between dupilumab and lebrikizumab on continuous scales were small.”

References

1. ^{Drucker AM, Lam M, Prieto-Merino D, et al. Systemic Immunomodulatory Treatments for Atopic Dermatitis: Living Systematic Review and Network Meta-Analysis Update. JAMA Dermatol. Published online July 17, 2024. doi:10.1001/jamadermatol.2024.2192.}
2. ^{Drucker AM, Ellis A, Jabbar-Lopez Z, et al. Systemic immunomodulatory treatments for atopic dermatitis: protocol for a systematic review with network meta-analysis. BMJ Open. 2018;8(8):e023061. doi:10.1136/bmjopen-2018-023061.}