Lebrikizumab improved skin clearance, itch, and pigmentary changes in adult and adolescent patients with skin of color and moderate-to-severe atopic dermatitis over 24 weeks, with no new safety concerns.
At week 16, 69% of patients achieved at least a 75% improvement in Eczema Area and Severity Index (EASI 75). Nearly half achieved 90% improvement (EASI 90) or clear to almost clear skin (IGA 0/1). Among those with significant baseline itch, 58% reported a reduction of at least four points on the Pruritus Numeric Rating Scale.
By week 24, results improved. EASI 75 was achieved by 78% of patients, EASI 90 by 47%, and IGA 0/1 by 54%. Response rates by Fitzpatrick skin phototype were 63% for type IV, 88% for type V, and 96% for type VI. Among patients with baseline hyperpigmentation, 64% improved and about one-quarter achieved normal skin tone. Patient-reported scores decreased by more than half from baseline, and 69% reported being mostly or completely satisfied with treatment.
Treatment-emergent adverse events occurred in 32% of patients, most mild or moderate. No serious adverse events or discontinuations were reported. Infections occurred in 10% of patients, and skin infections in 3%.
The phase 3b ADmirable trial enrolled 90 patients aged 12 years and older with Fitzpatrick skin phototypes IV to VI and self-reported race other than White. All had moderate-to-severe atopic dermatitis inadequately controlled with topical therapy. Patients received a 500 mg loading dose of lebrikizumab at baseline and week 2, followed by 250 mg every 2 weeks for 16 weeks. Responders at week 16 switched to dosing every 4 weeks, while nonresponders continued every 2 weeks until week 24.
Pigmentary changes were evaluated with PDCA-Derm, and patient-reported outcomes included itch, skin pain, and PO-SCORAD. Safety was assessed through adverse event reporting, laboratory data, and vital signs.
The study’s open-label design and absence of a placebo control limit direct comparisons. The 24-week duration was relatively short, and more than one-third of patients used concomitant topical therapy, which may have influenced outcomes. The Fitzpatrick scale was not designed for assessing skin of color, and erythema-based scoring systems may underestimate severity in darker skin. The trial was conducted only in the United States, limiting generalizability.
Lebrikizumab improved disease severity, itch, and pigmentary outcomes in patients with skin of color and moderate-to-severe atopic dermatitis over 24 weeks, with no new safety concerns. Longer, controlled studies are needed to confirm these findings and assess long-term outcomes.
Full disclosures can be found in the published study.