Jenny Murase, MD: Lebrikizumab’s Evolving Role in Atopic Dermatitis

Jenny Murase, MD

Credit: Sutter Health

A series of phase 3 trial analysis data presented at the Revolutionizing Atoipc Dermatitis (RAD) 2023 Spring Conference this weekend bolstered the understood capability of investigative lebrikizumab in the treatment of moderate to severe atopic dermatitis.

Among the presented trials was an assessment showing the interleukin-13 (IL-13) inhibitor was associated with a majority of successfully treated patients achieving benefit for face and/hand eczema—a difficult-to-reach outcome for systemic therapies.¹

The new data come within short time of an anticipated US Food and Drug Administration (FDA) decision on the Eli Lilly application for lebrikizumab to treat atopic dermatitis, on the basis of the ADhere and ADvocate trial findings.

In an interview with HCPLive during RAD 2023, lebrikizumab investigator Jenny Murase, MD, associate clinical professor of dermatology at the University of California San Francisco and director of medical dermatology consultative services and patch testing for the Palo Alto Foundation Medical Group, discussed the significance and details into her team’s assessment of the agent for face and hand dermatitis, the unique characteristics of lebrikizumab, and what more needs to be understood about it leading up to a potential marketing decision.

HCPLive: What exactly are patients who experience eczema on their hands and face are going through that makes them more pivotal targets for research and treatment?

Murase: I think that having atopic dermatitis, in terms of its impact on quality of life, with the pruritus that you experience—it's somewhere between having cystic fibrosis and having a kidney transplant. There's a huge impact on quality of life, because of the severity of the itch, but then when the hands and face in particular are involved, then the impact on quality of life goes up even more so.

Patients feel like they can't leave the house because their face is covered in dermatitis that can be cracking, oozing. They can't use their hands just function because there's fissures and pain associated with the disease. So, it just makes it that much more impactful to have those 2 areas of the body in particular involved.

With that in mind, how exactly do the characteristics of lebrikizumab—its efficacy, mechanism of action and its administration—help result in benefit for patients with hand and face eczema?

I think that when patients are deciding to go from topical therapy and/or light treatment to a systemic agent, there's a step that needs to be made where the patient is trying to decide if it's worth it to take some kind of oral pill or injectable medication. And oftentimes in clinic, patients want to be on something that does not require blood tests, because they're concerned about the risk associated with even needing a blood test to evaluate how they are doing on a medication.

So, lebrikizumab definitely has a benefit in the sense that there are no blood tests required. And it's an injection every other week, twice a month, which I think that most patients are open to. I think that it's fairly easily administered and the fact that it doesn't require blood tests is definitely something that patients are more open to as a result.

Another topic that came up frequently at RAD 2023 this week was the state of the armamentarium that is have available across systemic and biologic agents for atopic dermatitis. How exactly does this latest data alter the potential standing of lebrikizumab in the atopic dermatitis armamentarium, pending FDA decision?

I think that for the agents that are associated with IL-13, in my opinion, there's a lot of misinformation about the origin of the facial erythema in terms of whether they have an impact on facial dermatitis. I published on this quite extensively; I have one of the largest papers on facial dermatitis and using a different agent, but similar in the sense that it's IL-4 and IL-13 agents. And I think it's important for people to realize that these agents can actually positively impact the face. There is an association with facial erythema. But oftentimes, that's something that requires diagnostic testing to delineate what are the causes of the facial rash.

What I found in the study that I did was that patch testing uncovered allergens, that then once those were removed the face cleared. So, there was concomitant allergic contact dermatitis on top of atopic dermatitis. I think that using diagnostic testing such as patch testing can be very helpful. But then more importantly, realizing that these agents actually do improve the face and hands is very important. I certainly hope that clinicians moving forward realize this, and that if a patient has involvement of the face that they still consider these agents because they can be helpful in the majority of patients that are experiencing issues on their face and hands.

What exactly are you excited to learn more about lebrikizumab in treating atopic dermatitis in further late-stage or real-world assessments?

In terms of its efficacy, relative to the other agents within its class, it'll be interesting to see in a real-world experience how it plays out, because I consider this class of agents to be very safe for patients. When someone has failed light therapy and/or topical therapy, and they're ready for a systemic agent, I think that this is an excellent class to try initially, regardless of where the dermatitis is severely affecting the body. I think it's an excellent choice to start with, because of the safety profile and being relatively low-risk compared to any other systemic agent class for atopic dermatitis.

I am excited to see how it plays out in terms of the efficacy, as well as the frequency of dosing, because I know patients like to be on as little medicine as they need to control their conditions. It's compelling that once-monthly dosing is an option for these patients.

References

1. ^{K Kunzmann. Lebrikizumab Improves Hand and Face Dermatitis in Most Patients at 16 Weeks. HCPLive. Published May 3, 2023. https://www.hcplive.com/view/lebrikizumab-improves-hand-face-dermatitis-most-patients-16-weeks}