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

1.1 Abrocitinib and upadacitinib are recommended as options for treating moderate to severe atopic dermatitis that is suitable for systemic treatment in adults and young people 12 years and over, only if:

1.2 Tralokinumab is recommended as an option for treating moderate to severe atopic dermatitis that is suitable for systemic treatment in adults, only if:

1.3 Stop abrocitinib, upadacitinib or tralokinumab at 16 weeks if the atopic dermatitis has not responded adequately. An adequate response is:

1.4 Take into account how skin colour could affect the EASI score, and make any appropriate adjustments.

1.5 Take into account any physical, psychological, sensory or learning disabilities, or communication difficulties that could affect the responses to the DLQI, and make any appropriate adjustments.

1.6 These recommendations are not intended to affect treatment with abrocitinib, upadacitinib or tralokinumab 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 systemic immunosuppressants are not effective.

The clinical trial evidence shows that abrocitinib, tralokinumab and upadacitinib all reduce symptoms of atopic dermatitis compared with placebo. Abrocitinib and upadacitinib were indirectly compared with ciclosporin, but the results are highly uncertain.

Abrocitinib, upadacitinib and tralokinumab were each directly or indirectly compared with dupilumab and baricitinib for use after systemic immunosuppressants, but the results are uncertain.

Despite the uncertainty the most likely cost-effectiveness estimates are within the range that NICE normally considers an acceptable use of NHS resources. Therefore, abrocitinib, upadacitinib or tralokinumab are recommended as options for moderate to severe atopic dermatitis that has not responded to at least 1 systemic immunosuppressant.