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    Has all of the relevant evidence been taken into account?

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    Are the summaries of clinical and cost effectiveness reasonable interpretations of the evidence?

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    Are the recommendations sound and a suitable basis for guidance to the NHS?

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1 Recommendations

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1 Recommendations

1.1 Secukinumab is not recommended, within its marketing authorisation, for treating active moderate to severe hidradenitis suppurativa (acne inversa) in adults when the disease has not responded well enough to conventional systemic therapy.

1.2 This recommendation is not intended to affect treatment with secukinumab that was started in the NHS before this guidance was published. People having treatment outside this recommendation 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.

Why the committee made these recommendations

Current treatment for people with moderate to severe hidradenitis suppurativa when conventional systemic therapy has not worked well enough is adalimumab. The company has positioned secukinumab for people who cannot have adalimumab or whose condition has not responded to adalimumab. This is a narrower population than secukinumab is licensed for.

Evidence from 2 clinical trials shows that secukinumab generally improves symptoms of moderate to severe hidradenitis suppurativa more than placebo. The trials did not use the same treatments alongside secukinumab or placebo that are usually used for hidradenitis suppurativa in UK clinical practice. So, the benefit of secukinumab is unclear. Also, both trials are short so the longer-term effect of secukinumab is also unclear.

The cost-effectiveness estimates are all above what NICE considers an acceptable use of NHS resources. So, secukinumab is not recommended.