Atopic Dermatitis

Aim: Atopic dermatitis (AD) affects 2-7% of adults globally, with 30% experiencing moderate-to-severe disease.Although several treatments for moderate-to-severe AD are available, the efficacy of many treatments has not been compared in head-to-head trials.Using a network meta-analysis (NMA), we evaluated the relative efficacy between lebrikizumab, an emerging biologic and approved targeted systemic treatments for AD.Method: Double-blind, randomized, placebo-controlled clinical trials (systemic monotherapy-only) for moderateto-severe AD in adults (≥18 years) and adolescents (≥12 years to ≤18 years) published before April 2023 were identified in a systematic literature review.Data were extracted for short-term (12-16 weeks) efficacy outcomes (Investigator's Global Assessment [IGA] 0/1 with ≥2point improvement from baseline and the Eczema Area and Severity Index [EASI]) and patient-reported outcomes (Pruritus Numeric Rating Scale [NRS] with ≥4point improvement from baseline).Bayesian NMAs were performed using random-effects models, with baseline-risk adjustment.Key estimates from the NMAs included pairwise differences between all treatments and absolute response rates for each treatment.Results: Twenty-two clinical trials were included.For % achieving IGA 0/1, at 12-16 weeks, the estimated response rates (posterior median and 95% credible interval) for each of the treatments were: upadacitinib 30 mg 55.8% (43.7-64.2%),upadacitinib 15 mg 41.3% (30.1-50.0%),abrocitinib 200 mg 39.0% (29.8-47.8%),dupilumab 300 mg 31.8%(23.1-38.7%),lebrikizumab 250 mg 31.4% (24.1-39.2%),abrocitinib 100 mg 24.5% (17.5-32.0%),tralokinumab 300 mg 17.3% (12.8-22.2%),baricitinib 4 mg 16.7% (9.8-25.5%),baricitinib 2 mg 15.5% (9.6-22.0%)and placebo 6.0% (4.3-7.3%).Similar trends were observed for the EASI and pruritus NRS responses at 12-16 weeks.Conclusion: This 16-week NMA 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 option for moderateto-severe AD.