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IL-13 Inhibitor — Atopic Eczema Pregnancy: Avoid — limited data; use effective contraception; IgG crosses placenta

Lebrikizumab

Brand names: Ebglyss

Adult dose

Dose: 500 mg SC (two 250 mg injections) at weeks 0 and 2 (loading), then 250 mg every 2 weeks for 16 weeks (induction), then 250 mg every 4 weeks (maintenance if controlled)
Route: SC injection
Frequency: Every 2 weeks (induction) then every 4 weeks (maintenance)
Max: 250 mg every 2 weeks
IL-13 specific monoclonal antibody for moderate-to-severe atopic eczema in adults and adolescents ≥12 years. Similar target to tralokinumab (both IL-13 selective). High binding affinity for IL-13. NICE TA981 (2024) approved with rebate arrangement. Can be used with or without topical corticosteroids.

Paediatric dose

Dose: Weight-based (≥12 years): <60 kg — 250 mg loading × 2, then 125 mg every 2 weeks; ≥60 kg — adult dose mg/kg
Route: SC
Frequency: Every 2 weeks initially
Max: 250 mg every 2 weeks
Licensed from 12 years — weight-based dosing for adolescents under 60 kg

Dose adjustments

Renal

No dose adjustment required

Hepatic

No dose adjustment required

Paediatric weight-based calculator

Licensed from 12 years — weight-based dosing for adolescents under 60 kg

Clinical pearls

  • ADvocate-1 and ADvocate-2 trials: lebrikizumab monotherapy — 43–52% IGA 0/1 at week 16 vs 12–18% placebo; superior EASI-75 rates
  • ADhere trial (with TCS): 70% IGA 0/1 with lebrikizumab + TCS at week 16
  • Similar IL-13 target as tralokinumab — different binding epitope and pharmacokinetics; 4-weekly maintenance vs tralokinumab's 4-weekly (if controlled)
  • Lower conjunctivitis rate than dupilumab — both IL-13 selective antibodies avoid IL-4Rα signalling on conjunctival epithelium
  • NICE TA981 (2024): lebrikizumab approved for moderate-to-severe atopic eczema in adults (≥18 years) and adolescents (≥12 years) after failure of at least 1 systemic treatment
  • Maintenance dosing flexibility: responders at 16 weeks can continue on 4-weekly dosing — significantly reduces injection burden

Contraindications

  • Hypersensitivity to lebrikizumab
  • Active helminth infection (treat before initiating)

Side effects

  • Conjunctivitis (less common than dupilumab)
  • Injection site reactions
  • Upper respiratory tract infections
  • Herpes simplex reactivation
  • Allergic conjunctivitis

Interactions

  • Live vaccines — avoid during treatment

Monitoring

  • EASI score at 16 weeks (NICE: ≥75% reduction criterion)
  • IGA score
  • Conjunctivitis symptoms
  • Infection surveillance

Reference: BNFc; BNF 90; ADvocate-1 Trial (Silverberg et al. NEJM 2023); ADhere Trial; NICE TA981; SPC Ebglyss. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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