NICE has chosen not to recommend three drugs used for the treatment of moderate-to-severe atopic dermatitis, in part because of their uncertain cost-effectiveness

eczema on hand

In a recent appraisal consultation, NICE has not recommended the drugs upadacitinib, abrocitinib, and tralokinumab for the treatment of moderate-to-severe atopic dermatitis (eczema).

NICE’s decision is not likely to affect patients who started treatment with the drugs before the guidance was published.

Current options

The prevalence of atopic dermatitis in the UK remains high, with 11–20% of children and 5–10% of adults being affected. The treatment goal is to provide initial symptom relief followed by long-term control of symptoms.

Standard treatment options for moderate-to-severe atopic dermatitis include topical treatments such as emollients and corticosteroids. Systemic immunosuppressants such as methotrexate and ciclosporin can be further added if topical treatments are ineffective, then targeted biological therapies, dupilumab, and baricitinib can be considered if these systemic treatments fail. Phototherapy can also be considered for severe cases.

Patients whose condition does not respond to existing treatments, or who are unable to tolerate them, have an unmet treatment need.

Lack of evidence

Evidence from clinical trials shows abrocitinib, upadacitinib, and tralokinumab to be effective in reducing the symptoms of atopic dermatitis compared with placebo. However, when they were indirectly compared with the currently available standard treatments, the findings were highly uncertain.

‘The limitations in clinical evidence mean the results from the economic model are also highly uncertain. As such, it is challenging to determine the cost-effectiveness of the drugs,’ NICE said in a press statement.

The approval committee seeks additional cost-effectiveness data, following which NICE may reconsider its decision at a meeting next month.

This article was originally published on Medscape UK, part of the Medscape Professional Network.

Lead image: Ольга Тернавская/
Image 1: Ольга Тернавская/