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Activated T cells drive a range of immune‐mediated inflammatory diseases. LAG‐3 is transiently expressed on recently activated CD4+ and CD8+ T cells. We describe the engineering and first‐in‐human clinical study (NCT02195349) of GSK2831781 (an afucosylated humanized IgG1 monoclonal antibody enhanced with high affinity for Fc receptors and LAG‐3 and antibody‐dependent cellular cytotoxicity capabilities), which depletes LAG‐3 expressing cells. GSK2831781 was tested in a phase I/Ib, double‐blind, placebo‐controlled clinical study, which randomized 40 healthy participants (part A) and 27 patients with psoriasis (part B) to single doses of GSK2831781 (up to 0.15 and 5 mg/kg, respectively) or placebo. Adverse events were generally balanced across groups, with no safety or tolerability concern identified. LAG‐3+ cell depletion in peripheral blood was observed at doses ≥ 0.15 mg/kg and was dose‐dependent. In biopsies of psoriasis plaques, a reduction in mean group LAG‐3+ and CD3+ T‐cell counts was observed following treatment. Downregulation of proinflammatory genes (IL‐17A, IL‐17F, IFNγ, and S100A12) and upregulation of the epithelial barrier integrity gene, CDHR1, was observed with the 5 mg/kg dose of GSK2831781. Psoriasis disease activity improved up to day 43 at all GSK2831781 doses (0.5, 1.5, and 5 mg/kg) compared with placebo. Depletion of LAG‐3‐expressing activated T cells is a novel approach, and this first clinical study shows that GSK2831781 is pharmacologically active and provides encouraging early evidence of clinical effects in psoriasis, which warrants further investigation in T‐cell‐mediated inflammatory diseases.

Ecological studies enable investigation of geographic variations in exposure to environmental variables, across groups, in relation to health outcomes measured on a geographic scale. Such studies are subject to ecological biases, including pure specification bias which arises when a nonlinear individual exposure-risk model is assumed to apply at the area level. Introduction of the within-area variance of exposure should induce a marked reduction in this source of ecological bias. Assuming several measurements per area of exposure and no confounding risk factors, we study the model including the within-area exposure variability when Gaussian within-area exposure distribution is assumed. The robustness is assessed when the within-area exposure distribution is misspecified. Two underlying exposure distributions are studied: the Gamma distribution and an unimodal mixture of two Gaussian distributions. In case of strong ecological association, this model can reduce the bias and improve the precision of the individual parameter estimates when the within-area exposure means and variances are correlated. These different models are applied to analyze the ecological association between radon concentration and childhood acute leukemia in France.