Significance of New Phase 3 Lebrikizumab Trial in Nummular Eczema, With Kilian Eyerich, MD, PhD

The phase 3 LumiNE trial evaluating lebrikizumab in adults with nummular eczema has been initiated by Almirall, broadening investigation of the interleukin (IL)-13 inhibitor beyond its currently approved use in moderate-to-severe atopic dermatitis. The analysis reflects the company’s continued focus on advancing targeted dermatology therapies while also incorporating patient-centered outcome measures into clinical research.1

In his new interview with HCPLive, Kilian Eyerich, MD, PhD, Eyerich described nummular eczema as a common yet historically understudied inflammatory skin condition. The disease lacks approved targeted medications, Eyerich noted, despite its significant impact on patients’ quality of life. Nummular eczema, also known as discoid eczema, is linked with chronic pruritus, recurrent flares, disruption of sleep, and psychosocial burden, and it can occur either independently or alongside atopic dermatitis.2

Eyerich speaks in the second segment of his interview about several topics, including growing challenges faced by clinicians such as patient topical corticosteroid (TCS) hesitancy, withdrawal concerns, and the need for more effective treatment options for this difficult-to-control disease:

HCPLive: Many clinicians still rely heavily on topical corticosteroids for nummular eczema management. What challenges do you commonly see with current treatment approaches, particularly in patients with persistent or difficult-to-control disease?

Eyerich: I think it's super important that you mention this exception. I would say in the majority of patients that have a mild no eczema, topical cortical steroids are still okay as long as we don't use them regularly and at high potency in sensitive areas. The main problem with TCS these days is that in the moderate and severe patients, they won't be enough. But that's only one point. Other aspects are that many patients just don't want it anymore, especially in the case of nummular eczema. These are often elderly patients that have treated their skin for many years, and they say, 'Please, every dermatologist tells me the same: use topical corticosteroids, I used them for a couple of days. Things get a little better, but as soon as I stop, the disease comes back worse than it was before.’

That's one aspect. Then we have a lot of topical corticosteroid phobia and topical corticosteroid withdrawal syndrome in social media, so it is pretty difficult to find an agreement on shared decision-making with the patients that should be on a topical corticosteroid scheme only. Again, if they have moderate to severe variants of nummular eczema, this is typically not enough. And we do see side effects of these TCS, especially in elderly patients that already have a thin skin. They tend to have an easy bleeding, wound healing, delay, and all the side effects that TCS have. In other words, modern and specific effective treatments and nummular eczema are desperately missing at this step, especially in a population with moderate to severe variants.

HCPLive: The LumiNE trial includes endpoints assessing investigator global assessment, itch reduction, and quality of life. Why is it important to evaluate both clinical severity and patient-reported burden in nummular eczema studies?

Eyerich: This is a general insight that we in dermatology have made over the last decade or so, that in order to make a good shared decision process and treatment regimen, we always need the two different aspects. We need the physician-based, more or less objective, score, as well as patient-reported outcome measurements and insights, and in all kinds of dermatological diseases. But even beyond dermatology, typically, treatment aims and treatment goals nowadays consist of these two different aspects. It is a modern approach to look at the outcome of IL-13 inhibition and nominal eczema, and I think it is a very important one.

HCPLive: As interest grows in targeted therapies across inflammatory skin diseases, how do you see studies like LumiNE shaping the future conversation around biologic treatment strategies beyond traditional atopic dermatitis indications?

Eyerich: Thank you very much for this question, because it's for sure a hard one, but it's a very interesting one. What I do see, and that's my honest opinion as a dermatologist, is that we and the whole discipline learn a lot from specifically acting agents, such as biologics and antibodies, because we again come from an era where only the phenotype matters to make up the diagnosis. In reality, phenotypes are overlapping and heterogeneous, and that's most likely why we do have a substantial proportion of non-responders in all kinds of clinical trials we do in dermatology.

Now, what we have to say is that using anti IL-13 as an example here, lebrikizumab, gives us also insights into the biology underlying the diseases. As I said before, nummular eczema has an IL-13 component, but also neutrophil granulocyte component. But we do see that IL-13 component seems to be the dominant one, and by shaping these individual diseases we get a better understanding of inflammatory skin diseases in general, where we do have atopic dermatitis and its sister disease, prurigo, but also now, nummular eczema. The next step for me would then be to identify that these diseases are somehow interrelated when it comes to therapeutic choice, right?

Neutralizing IL-13 would have a very high probability of success. The step after that, that's the future of dermatology in the field of inflammatory skin diseases. As I see it, it would be that we don't necessarily crawl on the traditional disease ontology, but rather we say, this is a group of diseases responding to, for example, interleukin-13 antagonists. Using that, we may get rid of the 99% of diagnoses at the moment that will always be off-label, because they are ill-defined, we don't have good endpoints there, they may be rare, but these patients should benefit actually from the development progress that we do, and not only the patients in the few diseases where we have studies investigating specific drugs.

The quotes contained in this video summary were edited for the purposes of clarity.

Disclosures: Eyerich has previously reported personal fees from Janssen, AbbVie, Almirall, Boehringer Ingelheim, LEO Pharma, Lilly, Novartis, and Sanofi.

References

1. Almirall announces “LumiNE”, a phase III clinical study assessing the efficacy of Lebrikizumab for the treatment of nummular eczema. Almirall, S.A. January 15, 2026. Accessed May 22, 2026. https://www.almirall.com/news-media/newsroom/almirall-announces-lumine-phase-iii-clinical-study-assessing-efficacy.

2. Böhner A, Jargosch M, Eyerich K, et al. The neglected twin: Nummular eczema is a variant of atopic dermatitis with codominant TH2/TH17 immune response. J Allergy Clin Immunol. 2023 Aug;152(2):408-419. doi: 10.1016/j.jaci.2023.04.009. Epub 2023 Apr 27. PMID: 37119871.