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Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis

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1 Recommendations

1.1 Abrocitinib and upadacitinib are not recommended, within their marketing authorisations, for treating moderate to severe atopic dermatitis that is suitable for systemic treatment in adults and young people 12 years and over.

1.2 Tralokinumab is not recommended, within its marketing authorisation, for treating moderate to severe atopic dermatitis that is suitable for systemic treatment in adults.

1.3 These recommendations are not intended to affect treatment with abrocitinib, tralokinumab and upadacitinib that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. In young people this decision should be made jointly by them, their clinician, and their parents or carers.

Why the committee made these recommendations

Standard treatment for moderate to severe atopic dermatitis (eczema) includes topical treatments such as emollients and corticosteroids. If these treatments are not effective, systemic immunosuppressants such as methotrexate and ciclosporin can be added. Dupilumab and baricitinib are used if these systemic treatments are not effective.

Clinical trial evidence shows that abrocitinib, tralokinumab and upadacitinib all reduce symptoms of atopic dermatitis compared with placebo. They have been indirectly compared with some standard treatments, but the results are highly uncertain.

The limitations in the clinical evidence mean the results from the economic model are very uncertain. Because of this it is not possible to determine a suitable cost-effectiveness estimate for abrocitinib, tralokinumab and upadacitinib. So, they cannot be recommended.