A Durability Index for Atopic Dermatitis: Indirect Comparison of Lebrikizumab, Dupilumab, and Tralokinumab in Maintaining Efficacy Under Variable Treatment Adherence
Journal
Dermatology and Therapy
ISSN
2193-8210
2190-9172
Date Issued
2026-06-17
Author(s)
Silverberg, Jonathan I.
Irvine, Alan D.
Foley, Peter
Del Rosso, James
Puig, Luis
Stein Gold, Linda
Kamata, Masahiro
Wollenberg, Andreas
Hong, H. Chih-ho
et al.
Abstract
Introduction: Real-world management of moderate-to-severe atopic dermatitis (AD) may involve treatment interruptions. This indirect comparison evaluated the efficacy of lebrikizumab, dupilumab, and tralokinumab monotherapy in achieving week-52 response at variable adherence levels.
Methods: This indirect comparative analysis used data from the induction (week 0-16) and maintenance (week 16-52) phases of the ADvocate, SOLO, and ECZTRA monotherapy trials. A novel Durability Index (DI) was used to estimate week 52 response from week 0 at variable maintenance adherence levels. To estimate the impact of adherence, reported maintenance responses in the continuous treatment (100% adherence) and withdrawal (0% adherence) arms were weighted by the assumed proportion of patients remaining on treatment, with intermediate adherence levels estimated by linear interpolation. Responses included an Investigator's Global Assessment (IGA) score of 0/1 or ≥ 75% improvement in Eczema Area Severity Index (EASI 75). Odds ratios (ORs) and risk differences (RD) with 95% confidence intervals (CIs) were estimated.
Results: Lebrikizumab had significantly greater efficacy than dupilumab of achieving week 52 IGA 0/1 for adherence rates between 0% (OR 3.4, 95% CI 1.3-11.3) and 78% (OR 1.5, 1.0-2.5) and EASI 75 for adherence rates between 0% (OR 2.6, 1.4-5.0) and 63% (OR 1.4, 1.0-2.0). At higher adherence rates, lebrikizumab had comparable efficacy to dupilumab. Lebrikizumab had significantly better efficacy than tralokinumab of achieving week 52 responses for all adherence rates for IGA 0/1 (0%: OR 2.5, 1.1-5.9; 100%: OR 2.6, 1.6-4.2) and EASI 75 (0%: OR 5.3, 2.8-10.4; 100%: OR 3.2, 2.2-4.8). Dupilumab had significantly better efficacy than tralokinumab of achieving IGA 0/1 at adherences rates above 69% and EASI 75 across all adherence rates. RDs were consistent with differences observed for ORs.
Conclusions: In this indirect comparative analysis, lebrikizumab was associated with comparable or superior efficacy relative to dupilumab and superior efficacy relative to tralokinumab across all adherence rates in moderate-to-severe AD. As the DI is a novel metric, these findings should be interpreted cautiously, and independent validation of the DI is needed to ensure its clinical utility.
Subjects
Atopic dermatitis
Dupilumab
Durability Index
Eczema Area and Severity Index
Investigator Global Assessment
Lebrikizumab
Maintenance efficacy
Tralokinumab
Treatment adherence
Publisher
Springer Science and Business Media LLC
Type
journal-article