Efficacy of Targeted Systemic Monotherapies for Moderate-to-Severe Atopic Dermatitis: A Network Meta-Analysis

A recent study, published in SKIN The Journal of Cutaneous Medicine, has compared the efficacy of various targeted systemic monotherapies for moderate-to-severe atopic dermatitis (AD), including the emerging biologic lebrikizumab.

The study systematically reviewed double-blind, randomized, placebo-controlled clinical trials published before April 2023, focusing on systemic monotherapy treatments for adults and adolescents aged 12 to 18 years with moderate-to-severe AD. The primary efficacy outcomes assessed were the percentage of patients achieving an Investigator’s Global Assessment (IGA) score of 0 or 1 with at least a 2-point improvement from baseline, and the Eczema Area and Severity Index (EASI). Additionally, patient-reported outcomes, specifically the Peak Pruritus Numeric Rating Scale (PP-NRS) with at least a 4-point improvement from baseline, were analyzed.

Using Bayesian network meta-analysis (NMA) with random-effects models and baseline-risk adjustment, the study evaluated pairwise differences and absolute response rates for each treatment over a short-term period of 12 to 16 weeks. The analysis included data from 23 clinical trials.

The results revealed the following estimated response rates for achieving an IGA score of 0/1 at 12-16 weeks (posterior median and 95% credible interval):

• Upadacitinib 30 mg: 56% (46-65%)
• Upadacitinib 15 mg: 42% (32-50%)
• Abrocitinib 200 mg: 38% (31-45%)
• Lebrikizumab 250 mg: 32% (25-40%)
• Dupilumab 300 mg: 32% (24-39%)
• Abrocitinib 100 mg: 26% (20-32%)
• Tralokinumab 300 mg: 18% (13-22%)
• Baricitinib 4 mg: 17% (10-25%)
• Baricitinib 2 mg: 16% (10-22%)
• Placebo: 6% (5-8%)

Similar trends were observed for EASI and PP-NRS responses, reinforcing the efficacy data.

“This 16-week NMA analysis shows that lebrikizumab had a similar response rate to dupilumab, the most widely used targeted systemic therapy for AD, and may represent a valuable treatment alternative for moderate-to-severe AD,” concluded the study authors.

Reference:

Silverberg J, Bieber T, Beck L, Masahiro K, et al. Efficacy comparison of targeted systemic monotherapies including lebrikizumab for moderate-to-severe atopic dermatitis: a network meta-analysis. SKIN The Journal of Cutaneous Medicine. 8. s313. 2024. 10.25251/skin.8.supp.313.