Predictive Factors for Poor Responders to Lebrikizumab in Real-World Treatment for Atopic Dermatitis: Transition of Clinical and Laboratory Indexes.

Background: Some patients with atopic dermatitis (AD) do not sufficiently respond to anti-interleukin-13 antibody lebrikizumab in real-world practice. Identifying predictive factors for poor responders to lebrikizumab is important to optimize treatment strategies for AD. Objective: To clarify predictive factors for poor responders to lebrikizumab, defined as patients with Investigator's Global Assessment >2 at week 12 or 24 of treatment in real-world practice. Methods: From May 2024 to April 2025, we conducted a prospective study in 124 Japanese AD patients treated with lebrikizumab. The transition of clinical and laboratory indexes was evaluated during 24-week lebrikizumab treatment, stratified by poor responders versus responders. We compared baseline characteristics between week 12 and 24 poor responders versus respective responders. Results: Both week 12 and 24 responders showed lower magnitudes of decreasing Eczema Area and Severity Index (EASI) throughout 24-week treatment compared with respective responders. Lactate dehydrogenase levels in both week 12 and 24 responders significantly decreased and plateaued at week 4, while there was no significant decrease in both week 12 and 24 poor responders. Total eosinophil count in both week 12 and 24 responders slightly increased at week 4 and 12, while there was no significant increase in both week 12 and 24 poor responders. Week 12 poor responders had higher baseline EASI compared with responders. Week 24 poor responders had higher body mass index (BMI) compared with responders. Conclusions: Higher baseline EASI may predict week 12 poor responders to lebrikizumab, while higher BMI may predict week 24 poor responders. These baseline characteristics could help optimize treatment for AD.