Lebrikizumab Compared With Dupilumab in Atopic Dermatitis

TOPLINE:

In a network meta-analysis (NMA) from a living systematic review, lebrikizumab and dupilumab showed similar efficacy in patients with atopic dermatitis (AD).

METHODOLOGY:

• Researchers evaluated data from an ongoing living systematic review and NMA (used to compare systemic medications) of 98 trials with 24,707 participants with moderate to severe AD who received systemic immunomodulatory treatments for 8 weeks or longer. (Lebrikizumab, which binds to interleukin-13, is approved for AD in Europe and is under review elsewhere.)
• Primary outcomes were the Eczema Area and Severity Index (EASI), Patient-Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI), and Peak Pruritus Numerical Rating Scale (PP-NRS).
• Researchers also assessed binary efficacy outcomes: The proportion of patients with 50%, 75%, and 90% improvement in EASI (EASI-50, -75, and -90) and success on the Investigator Global Assessment (IGA) (reduction of two points and score of 0 or 1).
• Safety outcomes included the proportion of participants experiencing serious adverse events and withdrawal due to adverse events.

TAKEAWAY:

• Compared with dupilumab (600 mg, then 300 mg every 2 weeks), lebrikizumab (500 mg at weeks 0 and 2, then 250 mg every 2 weeks) was associated with no significant difference in EASI (mean difference [MD], −2.0; 95% credible interval [CrI], −4.5 to 0.3), POEM (MD, −1.1; 95% CrI, −2.5 to 0.2), DLQI (MD, −0.2; 95% CrI, −2.1 to 1.6) scores, and PP-NRS (MD, 0.1; 95% CrI, −0.4 to 0.6) in studies up to 16 weeks.
• Dupilumab was associated with higher odds of achieving EASI-50 (odds ratio [OR], 1.4; 95% CrI, 1.0-2.0), EASI-75 (OR, 1.4; 95% CrI, 1.0-1.9), EASI-90 (OR, 1.5; 95% CrI, 1.1-2.2), and IGA success (OR, 1.3; 95% CrI, 0.9-1.9) than lebrikizumab.
• Comparisons between serious adverse events and withdrawals because of adverse events were imprecise.

IN PRACTICE:

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

SOURCE:

The study was led by Aaron M. Drucker, MD, Women’s College Hospital in Toronto, Ontario, Canada, and was published online on July 17 in JAMA Dermatology.

LIMITATIONS:

Trials including children with AD remain sparse, limiting the generalizability of the findings; the study did not include long-term extension data; and safety analyses were not clinically useful because of imprecise effect estimates. The limited number of head-to-head trials means some analyses were underpowered, and baseline severity scores may be decreasing over time.

DISCLOSURES:

This study was supported by the UK National Institute for Health Research. Five authors declared financial ties outside this work. Other authors had no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.