Letter to the Editor Regarding “Anchored Matching-Adjusted Indirect Comparison of the Long-Term Maintenance of Efficacy of Tralokinumab and Lebrikizumab in Patients with Moderate-to-Severe Atopic Dermatitis” - Summary - MDSpire
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Letter to the Editor Regarding “Anchored Matching-Adjusted Indirect Comparison of the Long-Term Maintenance of Efficacy of Tralokinumab and Lebrikizumab in Patients with Moderate-to-Severe Atopic Dermatitis”
To address the limitations of the anchored matching-adjusted indirect comparison (MAIC) of tralokinumab and lebrikizumab in atopic dermatitis.
Approach:
Analysis of Patient Populations: The analysis focused on a subset of patients who achieved week-16 responses, highlighting differences in response rates between treatments.
Comparison of Mechanisms: Tralokinumab and lebrikizumab target IL-13 but differ in binding sites and pharmacokinetics, affecting their clinical efficacy.
Evaluation of Withdrawal Arms: The withdrawal arms of the trials were deemed not comparable due to different treatments received prior to withdrawal.
Key Findings:
Response rates at week 16 were 52% for lebrikizumab and 28% for tralokinumab.
Lebrikizumab has a significantly higher binding affinity for IL-13 and achieves steady-state concentrations faster than tralokinumab.
Post-treatment withdrawal, 56% of lebrikizumab responders maintained EASI 75 compared to 26% for tralokinumab.
Interpretation:
The differences in pharmacodynamics and patient selection raise concerns about the validity of the MAIC conclusions.
Limitations:
The analysis was based on a selective patient population, which may not represent the broader patient population.
The MAIC approach cannot account for unmeasured differences in treatment response between the cohorts.
Conclusion:
The findings suggest that lebrikizumab may offer superior long-term efficacy maintenance compared to tralokinumab, but the analysis has significant limitations.
Recognizing sustained switches between the two diseases can prevent premature discontinuation of effective biologics and point toward Janus kinase inhibitors, a 148-patient cohort suggests.
