From the Guidelines
Dupilumab is the preferred treatment option for atopic dermatitis in patients 12 years and above due to its more extensive long-term safety data and established efficacy in reducing disease severity and improving quality of life, as compared to lebrikizumab which has a similar mechanism of action but less extensive safety data 1.
Key Considerations
- Both dupilumab and lebrikizumab are monoclonal antibodies targeting the IL-13 pathway, with dupilumab also targeting IL-4.
- Dupilumab is FDA-approved for moderate-to-severe atopic dermatitis in patients 6 months and older, while lebrikizumab was more recently approved for atopic dermatitis in patients 12 years and older.
- In separate clinical trials, both medications have shown efficacy in reducing disease severity and improving quality of life.
- Common side effects for both include injection site reactions and conjunctivitis.
Treatment Recommendations
- Dupilumab is typically administered as a 600mg loading dose followed by 300mg every other week.
- Lebrikizumab is given as a 500mg loading dose followed by 250mg every two weeks.
- When choosing between these medications, consider factors such as insurance coverage, patient preference for injection frequency, and individual response.
- A trial of either medication for at least 16 weeks is recommended to assess efficacy before considering a switch to the alternative option, as suggested by recent guidelines 1.
Ocular Surface Disorders
- Both dupilumab and lebrikizumab have been associated with an increased risk of ocular surface disorders, including conjunctivitis.
- Close monitoring and liaison with ophthalmology is essential, especially in children and patients with a history of ocular surface disorders 1.
From the Research
Clinical Studies Comparing Dupilumab vs. Lebrikizumab for Atopic Dermatitis
- There are no direct clinical studies comparing dupilumab vs. lebrikizumab for 12 years and above atopic dermatitis cases in the provided evidence.
Available Studies on Dupilumab for Atopic Dermatitis
- A study published in 2021 2 demonstrated the efficacy and safety of dupilumab in adolescents (12-17 years) with moderate-to-severe atopic dermatitis.
- Another study published in 2020 3 showed that dupilumab is safer and more efficient than immunosuppressive drugs in treating severe atopic dermatitis.
- A review of real-world data on the long-term safety of dupilumab in atopic dermatitis patients found that it is well-tolerated, but ocular adverse events are not rare 4.
- A phase 3 open-label extension study published in 2020 5 found that dupilumab shows long-term safety and efficacy in patients with moderate to severe atopic dermatitis.
Combination of Dupilumab with Other Monoclonal Antibodies
- A study published in 2023 6 found that the combination of dupilumab with other monoclonal antibodies may be safe, but the evidence is modest and more research is needed to confirm this.
Limitations
- There are no clinical studies directly comparing dupilumab vs. lebrikizumab for 12 years and above atopic dermatitis cases in the provided evidence.
- More research is needed to fully understand the safety and efficacy of dupilumab in combination with other monoclonal antibodies.