Secukinumab is recommended as an option for treating active moderate to severe hidradenitis suppurativa (acne inversa) in adults when it has not responded well enough to conventional systemic treatment, only if:
adalimumab is not suitable, did not work or has stopped working
the company provides secukinumab according to the commercial arrangements.
Assess response to secukinumab after the first 16 weeks of treatment, and only continue if there is clear evidence of a response, defined as:
a reduction of 25% or more in the total abscess and inflammatory nodule count, and
no increase in abscesses and draining fistulas.
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 treatment (for example, oral antibiotics) has not worked well enough is adalimumab. For this evaluation, the company asked for secukinumab to be considered only for people who cannot have adalimumab or whose condition has not responded or has stopped responding to it. This does not include everyone who secukinumab is licensed for.
Evidence from 2 clinical trials shows that secukinumab generally improves symptoms of moderate to severe hidradenitis suppurativa more than placebo in the people the company has asked for it to be considered for.
The most likely cost-effectiveness estimates are within what NICE considers an acceptable use of NHS resources. So, secukinumab is recommended.