Dr. Shawn Kwatra Analyzes ADtouch Data on Hand and Foot Atopic Dermatitis

New Phase 3b ADtouch data for lebrikizumab-lbkz (Ebglyss; Eli Lilly and Company) may help broaden how dermatologists assess disease burden in patients with atopic dermatitis (AD) affecting high-impact areas, according to study investigator Shawn Kwatra, MD.

As previously reported by Practical Dermatology, 53% of patients treated with lebrikizumab achieved clear or almost clear hands and feet at week 16 compared with 27% receiving placebo. The randomized, double-blind trial included 221 patients aged 12 years or older with moderate-to-severe atopic hand and foot dermatitis and an inadequate response to topical therapies.

Hand and Foot AD Can Carry Disproportionate Disease Burden

“The key is not to let the low body surface area (BSA) underestimate disease burden,” Dr. Kwatra told Practical Dermatology. “When atopic dermatitis involves the hands and the feet, even a relatively small area of involvement can have a major impact on function.”

BSA, he added, “tells us how much skin is involved but does not tell us how much it is affecting the patient.”

“It’s not ‘What percentage of the body is affected?’ It’s ‘Where is the disease?’ ‘What is it preventing this patient from doing?’ ‘How much itch and pain are they experiencing?’” Dr. Kwatra said. “When those high-impact areas—hands and feet—are affected and causing a substantial impairment, a low body surface area should not lead to a conclusion that the disease is mild.”

Speed of Itch and Pain Improvement on Lebrikizumab

Dr. Kwatra also pointed to the speed of symptom improvement demonstrated in ADtouch. Improvement in itch was evident by week 2, and at week 16, 57% of lebrikizumab-treated patients achieved at least a 4-point improvement in itch compared with 19% receiving placebo.

“Speed matters a great deal because these are areas they are using constantly,” he said. “They were not just getting better skin; they were also feeling better relatively earlier.”

The Importance of Acknowledging Pain in Special-Site Atopic Dermatitis

Pain may be another important component of special-site AD that clinicians can overlook. At week 16, 59% of lebrikizumab-treated patients achieved at least a 4-point improvement in pain compared with 19% receiving placebo.

“I am a big proponent of treating itch, but hand and foot disease highlights how important pain is,” Dr. Kwatra said. “If a patient can use their hands or walk with less pain, then that can translate into greater ability to work, exercise, sleep, and participate normally in daily life.”

He added that the findings may encourage clinicians to capture that burden more directly.

“One of the lessons for me,” Dr. Kwatra said, “is that we should probably ask about pain more routinely in patients with hand and foot AD. If we only ask about itch and look at BSA, we may miss a very major component of disease burden.”

Dr. Kwatra also explained the significance of the Atopic Hand Dermatitis Clearance Satisfaction (AHDCS) measure, which assessed patients’ satisfaction with their hand clearance. Among patients dissatisfied at baseline, 77% receiving lebrikizumab were satisfied or very satisfied at week 16 compared with 40% receiving placebo.

“The hand-foot Investigator Global Assessment (IGA) tool tells us from the investigator's perspective how clear the hands look, but the AHDCS question asks: Is this level of improvement actually satisfactory to you as a patient?” Dr. Kwatra said.

“Treatment success, in my opinion, is not only a physician-defined threshold,” he added. “It includes reaching a level of control that the patient considers meaningful and acceptable in their daily life.”