OBJECTIVES: Lebrikizumab, Dupilumab and Tralokinumab are monoclonal antibodies for treating moderate-to-severe atopic dermatitis (AD). We compared the treatment response achieved during the Week 0-16 induction double-blind period of Lebrikizumab, Dupilumab and Tralokinumab administered biweekly in combination with low- to mid-potency topical corticosteroids in patients with prior cyclosporine A failure or contraindicated. Outcomes of interest were week 16 proportion of patients achieving a 75% improvement on the Eczema Area Severity Index (EASI-75), Investigator's Global Assessment score of 0 or 1 (IGA 0/1); and overall rate of adverse events.

METHODS: We used individual patient data (IPD) from adult patients enrolled in the ADvantage trial of Lebrikizumab. Dupilumab and Tralokinumab were evaluated using published aggregate data from the Liberty Ad Café and ECZTRA 7 trials. We employed anchored matching-adjusted indirect comparison (MAIC). Propensity score re-weighting was done to match baseline scores on the EASI and Body Surface Area as main effect modifiers.

RESULTS: The MAIC risk ratio (RR) for patients administered Lebrikizumab who achieved EASI 75 at week 16 compared to Dupilumab was 1.076 [0.662, 1.750] and compared to Tralokinumab was 1.739 [1.160, 2.606]. For IGA 0/1, the RR for Lebrikizumab vs Dupilumab were 0.867 [0.397, 1.892] and for Lebrikizumab vs Tralokinumab 1.535 [0.818, 2.878]. For the rate of adverse events, the RR for Lebrikizumab compared to Dupilumab 1.067 [0.850, 1.339] and Tralokinumab 1.141 [0.930, 1.401].

CONCLUSIONS: Adjusting for unequal distributions of effect modifiers between trials of AD patients with failed or contraindicated CsA, Lebrikizumab demonstrates equal week 16 efficacy compared to Dupilumab in terms of EASI 75 and IGA 0/1, and statistically superior performance to Tralokinumab for EASI 75 and not statistical superiority in IGA 0/1. Regarding overall Adverse events, Lebrikizumab demonstrates equal RR in front of both comparators.