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ID6221 nemolizumab atopic dermatitis DG to PM for consultation [NoCON] indev.docx

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1 Recommendations

1.1

Nemolizumab with topical corticosteroids, calcineurin inhibitors, or both, should not be used to treat moderate to severe atopic dermatitis that is suitable for systemic treatment in people 12 years and over with a body weight of 30 kg or more.

1.2

This recommendation is not intended to affect treatment with nemolizumab 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 healthcare professional consider it appropriate to stop. For young people, this decision should be made jointly by the healthcare professional, the young person, and their parents or carers.

What this means in practice

Nemolizumab is not required to be funded in the NHS in England to treat moderate to severe atopic dermatitis in people 12 years and over. It should not be used routinely in the NHS in England.

This is because the available evidence does not suggest that nemolizumab is value for money.

Why the committee made these recommendations

Usual treatment for moderate to severe atopic dermatitis (eczema) includes emollients, corticosteroids and calcineurin inhibitors applied to the skin (topical treatments). If these treatments are not effective, systemic immunosuppressants (such as ciclosporin and methotrexate) can be added. If these are also not effective, or unsuitable, a Janus kinase (JAK) inhibitor (such as abrocitinib, baricitinib or upadacitinib) or a biological medicine (such as dupilumab, lebrikizumab or tralokinumab) can be used.

Clinical trial evidence shows that nemolizumab is more effective than placebo at improving the symptoms of atopic dermatitis. It has not been directly compared in a clinical trial with JAK inhibitors or other biological medicines. Indirect comparisons suggest that it may work as well as most of these treatments, but this is uncertain.

There are also uncertainties in the economic model including the assumption around how long people stay on treatment.

The cost-effectiveness estimates are above the range that NICE considers an acceptable use of NHS resources. So, nemolizumab should not be used.

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