Lebrikizumab for Severe Atopic Dermatitis in a Patient With Prior Ocular Adverse Events

At presentation, the patient had extensive, severe AD involving approximately 80% of his body surface area (BSA), with an Investigator Global Assessment (IGA) score of 4. Examination revealed marked lichenification and prominent involvement of the head and neck, consistent with longstanding, poorly controlled disease.

The patient described a substantial symptom burden, rating his pruritus as 9/10 in severity. Persistent itching frequently disrupted his sleep and contributed to significant impairment in quality of life.

Together, the extent of skin involvement, severity of pruritus, sleep disruption, and inadequate disease control with previous therapies underscored the need for an effective long-term systemic treatment strategy.

Following a comprehensive discussion of available treatment options and in consultation with the patient’s ophthalmologist, lebrikizumab was initiated at the standard recommended dosing regimen.

At the week 6 follow-up visit, the patient demonstrated substantial clinical improvement. BSA involvement had decreased from 80% to 20%, and his IGA score had improved from 4 to 3. He also reported a reduction in pruritus, improved sleep, and greater ability to perform daily activities.

By week 12, the patient experienced continued improvement, with BSA involvement decreasing further to 10% and his IGA score improving to 2. Pruritus had also decreased substantially, with the patient reporting an average itch severity of 2 to 3/10, compared with 9/10 at baseline. Improvements in sleep quality were sustained, reflecting a meaningful reduction in the daily burden of AD.

The patient reported mild dry eye during treatment, which was managed with lubricating eye drops.

This case highlights the challenges of managing severe, longstanding AD in patients with extensive prior treatment exposure and a history of ocular complications. Although biologic therapies have expanded treatment options for moderate-to-severe AD, individual patient factors, including prior adverse events, comorbidities, and treatment preferences, remain important considerations when selecting systemic therapy.

The patient's history of ocular adverse events with dupilumab, together with retinal detachment and cataract surgery, added complexity to treatment selection and highlighted the importance of considering ophthalmologic history when initiating and monitoring subsequent therapy. His experience with mild dry eye during lebrikizumab treatment also illustrates the need for continued attention to ocular symptoms, even when substantial dermatologic improvement is achieved.

Following initiation of lebrikizumab, the patient experienced marked improvement in disease extent and severity over 12 weeks, accompanied by reductions in pruritus and improvements in sleep and daily functioning. These outcomes demonstrate the importance of evaluating treatment response beyond visible skin findings, particularly in patients whose disease has substantially affected quality of life.

Overall, this case illustrates the potential for meaningful disease control with lebrikizumab in a patient with severe AD and prior biologic intolerance, while emphasizing the value of individualized treatment selection and ongoing monitoring for ocular symptoms.