New data from the phase 3b ADapt study indicates that lebrikizumab-lbkz (Ebglyss) provides significant relief in skin symptoms and itch for patients with moderate-to-severe atopic dermatitis who had previously discontinued dupilumab treatment. The findings, presented at the 2024 Fall Clinical Dermatology Conference, highlight the potential of lebrikizumab as an effective alternative for patients who have not responded adequately to or have experienced adverse effects from dupilumab.
Efficacy in Dupilumab-Experienced Patients
The ADapt study assessed the efficacy and safety of lebrikizumab in individuals with moderate-to-severe atopic dermatitis who had discontinued dupilumab due to reasons such as insufficient treatment response, adverse events, or other factors. The primary endpoint was a 75% improvement in the Eczema Area and Severity Index score (EASI-75) at week 16. Secondary outcomes included an Investigator Global Assessment (IGA) score of clear (0) or nearly clear (1) skin at weeks 16 and 24, with a reduction of at least 2 points from baseline.
At week 16, 57% of participants treated with lebrikizumab achieved EASI-75, which increased to 60% by week 24. Notably, 46% of subjects with an inadequate response to dupilumab achieved EASI-75 with lebrikizumab at week 16. These results align with those from the phase 3 ADvocate 1 and ADvocate 2 studies, which evaluated lebrikizumab in patients who had not previously used dupilumab.
Significant Itch Reduction and Skin Improvement
In addition to improvements in overall skin condition, the study demonstrated a significant reduction in pruritus (itch) among patients. By week 16, 53% of participants who switched from dupilumab to lebrikizumab experienced a 4-point or greater reduction on the Pruritus NRS scale, increasing to 62% by week 24. Furthermore, 52% of subjects achieved clear or almost clear skin on their face by week 24, indicating improvements in particularly challenging regions.
Modified total lesion symptom scores (mTLSS) showed a 75% reduction by week 24 for subjects with severe hand dermatitis, further underscoring the drug's effectiveness in treating difficult-to-manage areas.
Safety Profile
The safety profile of lebrikizumab in the ADapt study was consistent with previous phase 3 trials, with no new safety risks observed. Fewer than 6% of participants discontinued the drug due to adverse effects. The most common side effects were mild to moderate, including conjunctivitis and reactions at injection sites. Importantly, only 2 of 14 individuals who had discontinued dupilumab due to adverse reactions discontinued lebrikizumab therapy for similar reasons, and none of those with facial dermatitis, eye-related problems, or inflammatory arthritis on dupilumab reported such events with lebrikizumab.
Mechanism of Action
Lebrikizumab is an interleukin (IL)-13 inhibitor designed to selectively block IL-13 signaling with high binding affinity. IL-13 is a key cytokine driving atopic dermatitis, specifically involved in the type-2 inflammatory cycle in patients' skin, which often results in skin barrier dysfunction, skin thickening, pruritus, and infection.
Expert Commentary
"These data showed that (lebrikizumab) improved skin symptoms and reduced itch for the majority of patients who had stopped using dupilumab and complement previously presented (lebrikizumab) data in biologic-naive patients, further supporting that a broad range of patients could benefit from this new and effective treatment option," said Linda Stein Gold, MD, ADapt study investigator and director of dermatology research for Henry Ford Health System.
