5PSQ-146 Maintenance of response at 52-week in moderate to severe atopic dermatitis: a network meta-analysis of therapeutic alternatives

<h3>Background and Importance</h3> Moderate to severe atopic dermatitis (AD) can be treated with several therapeutic alternatives. Recently, lebrikizumab has been approved in this pathology. <h3>Aim and Objectives</h3> To develop a network meta-analysis (NMA) to compare the efficacy in maintenance of response at 52-week of biologic treatments for moderate to severe AD. <h3>Material and Methods</h3> A PubMed literature search was conducted for phase III randomised clinical trials including biologic drugs (dupilumab, tralokinumab and lebrikizumab) compared to placebo in moderate to severe AD. Relevant clinical baseline characteristics of populations considered: age, gender, disease duration, EASI, IGA, BSA, NRS, DLQI. Efficacy endpoints were EASI-75 and IGA 0 or 1 achievement. Long-term maintenance results at week 52 were analysed. R v4.4.1 statistical software was used to perform the NMA. Odds ratio(OR) were calculated by Bayesian methods and fixed effect model were assessed. <h3>Results</h3> Five RCTs were selected. Age was similar in all populations. Male gender reached percentages of approximately 50% of patients, except for tralokinumab 300 mg Q2W(59.4%). Disease duration was generally between 25–27 years, being less durable in patients receiving lebrikizumab 250 mg Q2W (21.6 years). All presented with similar clinical characteristics at baseline: EASI≥16 (around 30), IGA 3 or 4, Body surface area ≥10% (between 45–50%), DLQI around 15, and POEM between 21–24. At week 52, dupilumab 300 mg Q2W achieved the greatest magnitude of effect for both EASI75 (OR 5.38; 95% CI 3–9.6) and IGA 0 or 1 (OR 5.54; 95% CI 2.6–11.8) achievement. Lebrikizumab (OR 2.21; 95% CI 1.1–4.3) reached better effect magnitude for IGA 0 or 1 achievement than tralokinumab (OR 1.97;95% CI 1–3.7) but, for EASI75 achievement, the effect was reversed, with tralokinumab (OR 2.63; 95% CI 1.4–4.8) showing a greater magnitude than lebrikizumab (OR 2.04; 95% CI 1–4). Regarding dupilumab 300 mg Q2W, statistically significant differences were found with lebrikizumab 250 mg Q2W for EASI75 achievement (p=0.0338) and with tralokinumab 300 mg Q2W for IGA 0 or 1 achievement (p=0.0415). Heterogeneity estimate values were: Q=0.0, p=0.05, I2=0% (CI 95% 0–0%). <h3>Conclusion and Relevance</h3> This NMA provided a review of efficacy of recent therapies for moderate to severe AD focusing on long-term response maintenance. Dupilumab 300 mg Q2W were the most effective schemes. Similar benefit was observed with tralokinumab 300 mg Q2W and lebrikizumab 250 mg Q2W. Further trials are needed to compare long-term outcomes of other therapies, such as JAK inhibitors. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest