First fully human monoclonal antibody IL-13 and IL-4-inhibitor significantly improves AD severity and is well tolerated, offering expanded biologic treatment options for eczema patients.

The results of a phase 3 trial expands on the efficacy and safety profile of tralokinumab, the first monoclonal antibody (mAb) that targets IL4Rα, blocking signaling of interleukin (IL)-13 and IL-4. Approved in the EU, UK, Canada, and the US for adults with moderate-to-severe atopic dermatis (AD), tralokinumab showed significant improvements in AD severity and was well-tolerated up to 52 weeks in patients who were switched from dupilumab. The clinical findings were presented in a poster at the SDPA 21st Annual Fall Dermatology Conference in Nashville, TN.

AD, or eczema, is a chronic relapsing inflammatory skin disease that negatively impacts the quality of life (QoL) of patients. The exact cause is unknown and the research on medicine that provides long-term disease control and a favorable safety profile are ongoing. Because individual eczema patients’ response to treatment can vary, research on how various medications can be sequenced is key to offering patients additional options if they fail or don’t respond to a given protocol.

This study indicates that patients who are treated with Dupilumab, a widely prescribed IL-13 inhibitor, who stop responding or can no longer receive the needed injections can safely be switched to Tralokinumab. Head-to-head studies of these two biologics have not been performed, and real-world evidence of tralokinumab use in moderate-to-severe AD patients that were previously treated with dupilumab is limited.

About the Study

Adult patients from 3 dermatology practices in the US with moderate-to-severe AD who were previously treated with dupliumab and subsequently switched to tralokinumab, were included.

Results

All patients experienced improvements in patient reported outcomes (PROs):

• 67% (6/9) of patients reported improvements in itch with Peak Pruritus Numerical Rating Scale (NRS) scores of 0 or 1
• 44% (4/9) reported general clearance of AD signs and symptoms of AD
• 44% (4/9) reported their overall satisfaction of being on tralokinumab
• AEs of conjunctivitis (3 patients) and joint pain (1) completely resolved in patients upon switching from dupilumab to tralokinumab
• Residual signs and symptoms of AD following initiation of tralokinumab were managed with antihistamines (1 patient), topical JAK inhibitors (1), and prednisone (1)

No AEs were reported except in one patient with possible mild seborrheic dermatitis/head-neck dermatitis eruption that was treated with topicals, and one patient with herpes labialis (it was unclear if this was related to the tralokinumab treatment). This case series suggests that tralokinumab is a potential effective therapy in patients with moderate-to-severe AD who have failed dupilumab, due to lack of efficacy or adverse events (AEs). Resolution of AEs of concern for biologic therapies for AD, such as conjunctivitis, was observed in patients upon switching from dupilumab to tralokinumab. Further studies are needed to elucidate if and how the different mechanisms of action of dupilumab and tralokinumab contribute to varying responses in patients.