The U.S. Food and Drug Administration (FDA) has approved Eli Lilly and Company's Ebglyss (lebrikizumab-lbkz) for the treatment of moderate-to-severe atopic dermatitis (eczema) in adult and pediatric patients (12 years and older weighing at least 88 pounds) whose disease is not adequately controlled with topical prescription therapies. This approval marks a significant advancement in the treatment landscape for atopic dermatitis, a chronic inflammatory skin condition affecting millions worldwide.
Mechanism of Action and Dosing
Ebglyss is a targeted interleukin-13 (IL-13) inhibitor designed to reduce inflammation throughout the body that leads to dry, itchy, and irritated skin associated with atopic dermatitis. The drug is administered via injection, with an initial dose of 500 mg (two 250 mg injections) at Week 0 and Week 2, followed by 250 mg every two weeks until Week 16 or later when adequate clinical response is achieved. Maintenance dosing consists of a single monthly injection (250 mg every four weeks). Ebglyss can be used with or without topical corticosteroids, offering flexibility in treatment regimens.
Clinical Trial Data
The FDA approval was based on data from three clinical trials: ADvocate 1, ADvocate 2, and ADhere. These studies involved over 1,000 adults and children (aged 12 and older) with moderate-to-severe eczema whose symptoms were not well-controlled by topical prescription medicines. The primary endpoint was assessed at 16 weeks, measuring clear or almost clear skin, defined as an Investigator's Global Assessment (IGA) score of 0 or 1.
In the ADvocate 1 and 2 trials, an average of 38% of patients treated with Ebglyss achieved clear or almost clear skin at 16 weeks, compared to 12% in the placebo groups. Some patients experienced improvements as early as four weeks into treatment. Furthermore, among those who achieved clear or almost-clear skin at Week 16, 77% maintained these results at one year with once-monthly dosing. In addition, 48% of responders who switched from Ebglyss to placebo at Week 16 maintained these results at one year.
Ebglyss also demonstrated significant improvements in itch relief. On average, 43% of patients treated with Ebglyss reported itch relief at 16 weeks, compared to 12% in the placebo groups. Some patients experienced relief as early as two weeks. Of those who felt itch relief at Week 16, 85% still felt that relief at one year of treatment with monthly maintenance dosing. Sixty-six percent of responders switched from Ebglyss to placebo at Week 16 maintained these results at one year.
Implications for Atopic Dermatitis Treatment
Atopic dermatitis is a chronic condition characterized by intense itching and inflammation, significantly impacting patients' quality of life. Current treatment options often include topical corticosteroids and systemic immunosuppressants, which may have limitations or side effects. Ebglyss offers a targeted approach by inhibiting IL-13, a key cytokine involved in the pathogenesis of atopic dermatitis, potentially providing a more effective and well-tolerated treatment option for patients with moderate-to-severe disease.
