Is lebrikizumab (anti-IL-13 monoclonal antibody) an appropriate treatment option for a patient with severe periorbital atopic dermatitis, elevated Immunoglobulin E (IgE), and a history of failed treatment with dupilumab (dupilumab), who is not controlled on topical corticosteroids or tacrolimus (tacrolimus)?

From the Guidelines

Lebrikizumab is not the most appropriate treatment choice for a patient with severe periorbital atopic dermatitis who has elevated IgE levels and has failed dupilumab therapy, due to its similar risk profile of ocular surface disease as dupilumab. According to the expert consensus on managing dupilumab-related ocular surface disorders in people with atopic dermatitis 1, biologics targeting the IL-13 pathway, such as tralokinumab and lebrikizumab, show an increased risk of ocular surface disease, similar to dupilumab.

Key Considerations

• The patient's history of elevated IgE levels and failure of dupilumab therapy suggests a need for alternative treatments that do not target the same pathways.
• The guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies 1 recommend considering other systemic therapies, such as Janus kinase inhibitors, which may have a different risk profile.
• The periorbital region's thin skin and poor response to conventional treatments make biologics a valuable option, but the choice of biologic should be guided by the patient's specific needs and risk factors.

Alternative Treatment Options

• Janus kinase inhibitors, such as abrocitinib, baricitinib, and upadacitinib, have been shown to be effective in treating moderate-to-severe atopic dermatitis and may have a lower risk of ocular surface disease compared to biologics targeting the IL-13 pathway.
• Other systemic therapies, such as azathioprine, cyclosporine, and mycophenolate, may also be considered, but their use should be guided by the patient's specific needs and risk factors.

Monitoring and Management

• Baseline laboratory tests, including complete blood count, liver function tests, and tuberculosis screening, should be performed before initiating therapy.
• Patients should be monitored for potential side effects, including injection site reactions, conjunctivitis, and upper respiratory infections.

From the FDA Drug Label

EBGLYSS™ is an interleukin-13 antagonist indicated for the treatment of adults and pediatric patients 12 years of age and older who weigh at least 40 kg with moderate-to-severe atopic dermatitis whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable. Lebrikizumab-lbkz is an IgG4 monoclonal antibody that binds with high affinity and slow off-rate to interleukin (IL)-13 and allows IL-13 to bind to IL-13Rα1 but inhibits human IL-13 signaling through the IL-4Rα/IL-13Rα1 receptor complex Lebrikizumab-lbkz inhibits IL-13-induced responses including the release of proinflammatory cytokines, chemokines and IgE.

Lebrikizumab may be an appropriate choice for a patient with severe periorbital atopic dermatitis, with a history of elevated IgE, who has failed treatment with dupilumab and is not controlled on topical steroids or tacrolimus, as it:

• Targets the IL-13 pathway, which is involved in the pathogenesis of atopic dermatitis
• Has been shown to reduce levels of serum periostin, total immunoglobulin E (IgE), and other biomarkers associated with atopic dermatitis 2
• Can be used with or without topical corticosteroids However, the decision to use lebrikizumab should be made on a case-by-case basis, taking into account the patient's individual circumstances and medical history.

From the Research

Patient Profile

• Severe periorbital atopic dermatitis
• History of elevated IgE
• Failed treatment with dupilumab
• Not controlled on topical steroids or tacrolimus

Lebrikizumab as a Treatment Option

• Lebrikizumab is a selective IL-13 inhibitor, which has shown efficacy in treating moderate-to-severe atopic dermatitis 3, 4, 5, 6, 7
• Studies have demonstrated that lebrikizumab provides rapid and dose-dependent efficacy in improving signs and symptoms of atopic dermatitis, including pruritus 4, 5
• Lebrikizumab has been shown to be effective in patients with moderate-to-severe atopic dermatitis, including those with elevated IgE levels 6
• The safety profile of lebrikizumab is generally favorable, with most adverse events being mild to moderate in severity 5, 7

Considerations for Treatment

• Lebrikizumab may be a suitable treatment option for patients who have failed dupilumab treatment, as it targets a different pathway (IL-13) 4, 6
• The patient's history of elevated IgE and severe periorbital atopic dermatitis suggests that lebrikizumab may be an effective treatment option 6
• However, it is essential to consider the patient's individual response to treatment and potential side effects, such as conjunctivitis, which has been reported in some studies 7

Clinical Evidence

• Phase 2b and phase 3 clinical trials have demonstrated the efficacy and safety of lebrikizumab in treating moderate-to-severe atopic dermatitis 5, 7
• Lebrikizumab has been approved for the treatment of moderate-to-severe atopic dermatitis, providing a new treatment option for patients who have failed other therapies 6