AD: Predictive value of early response for long-term efficacy

Maintenance trajectories of patients treated with tralokinumab for atopic dermatitis (AD) appear to be closely linked to their early treatment response. Participants who achieved an Eczema Area and Severity Index (EASI) 75/90 response and/or a dermatology Quality of Life Index (DLQI) 0/1 at week 16 tended to maintain their responses for up to 3 years.

 

The question Dr Andrew Blauvelt (Blauvelt Consulting LLC, OR, USA) and colleagues sought to answer was whether the initial response of AD to tralokinumab treatment could predict its stability over time [1]. They performed a post-hoc analysis of the phase 3 ECZTRA 3 trial (NCT03363854) and the subsequent open-label extension study ECZTEND (NCT03587805). Using these data, they assessed participants with EASI 75, EASI 90, or DLQI 0/1 at week 16 and followed their disease course over 3 years.

ECZTRA 3 included 253 tralokinumab-treated patients (300 mg every 2 weeks, plus as-needed topical steroids) with a mean age of 39.8 years, a mean EASI score of 28.8, and a mean DLQI score of 17.6. “This is a tough patient population in this particular trial,” Dr Andrew Blauvelt (Blauvelt Consulting LLC, Portland, OR, USA) noted.

Week 16 results for the subgroups of interest were: 56.0% achieved EASI 75, 32.9% achieved EASI 90 (‘super responders’), 24.6% achieved DLQI 0/1, and 15.5% achieved the composite of EASI 90 plus DLQI 0/1 (termed the ‘super-super responders’). Reviewing the individual disease courses of initial EASI 75 responders, Dr Blauvelt indicated that EASI 75 participants at week 16, on average, maintained responses near EASI 90 for the subsequent 2 to 3 years. Super responders also demonstrated a sustained improvement of ≥90% up to week 120. “Most of the patients are staying above an EASI 75 as they go through different seasons and get exposed to different allergens, so these lines indicate stability of the disease,” Dr Blauvelt commented, noting individual variations. Patient achieving DLQI 0/1 also tended to maintain a high quality-of-life, with an absolute DLQI remaining below 3 over 3 years. Interestingly, a substantial proportion of the “super-super responders” maintained a stable long-term response, with 58.8% sustaining both EASI 90 and DLQI 0/1 at week 120.

In addition, the absolute EASI at week 16 significantly predicted treatment response over time (P<0.0001). Dr Blauvelt highlighted that this was especially true for participants with an absolute EASI of 2 or less. “We think these results should help clinicians inform patients about what to expect in the future, especially those who do well in the first 4 months,” he concluded.

 

1. Blauvelt A, et al. Initial “super response” to tralokinumab leads to stable long-term response in patients with moderate-to-severe Atopic dermatitis: responder and predictor analysis from the ECZTRA 3 & ECZTEND trials. D3T01.5F, EADV Congress 2025, 17–20 September, Paris, France.

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Posted on 18 November 202518 November 2025