Lebrikizumab is recommended as an option for treating moderate to severe atopic dermatitis that is suitable for systemic treatment in people 12 years and over with a body weight of 40 kg or more, only if:
the atopic dermatitis has not responded to at least 1 systemic immunosuppressant or these treatments are not suitable, and
dupilumab or tralokinumab would otherwise be offered, and
the company provides it according to the commercial arrangement.
Stop lebrikizumab after 16 weeks if the atopic dermatitis has not responded adequately. An adequate response is:
at least a 50% reduction in the Eczema Area and Severity Index score (EASI 50) from when treatment started and
at least a 4‑point reduction in the Dermatology Life Quality Index (DLQI) from when treatment started.
Take into account how skin colour could affect the EASI score and make any clinical adjustments needed.
Take into account any physical, sensory or learning disabilities, or communication difficulties that could affect the responses to the DLQI, and make any clinical adjustments needed.
If people with the condition and their healthcare professionals consider lebrikizumab to be 1 of a range of suitable treatments, after discussing the advantages and disadvantages of all the options, the least expensive should be used. Administration costs, dosage, price per dose and commercial arrangements should all be taken into account.
These recommendations are not intended to affect treatment with lebrikizumab 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 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.
Why the committee made these recommendations
Standard treatment for moderate to severe atopic dermatitis (eczema) includes topical emollients and corticosteroids (treatments applied to the skin). If these treatments are not effective, systemic immunosuppressant treatments such as ciclosporin and methotrexate can be added. If there is an inadequate response after at least 1 of these systemic treatments, or if these are unsuitable, a Janus kinase (JAK) inhibitor (abrocitinib, baricitinib or upadacitinib) or a biological medicine (dupilumab or tralokinumab) can be used.
For this evaluation, the company asked for lebrikizumab to be considered only for people who have had at least 1 systemic immunosuppressant treatment. This does not include everyone who it is licensed for.
Clinical trial evidence shows that lebrikizumab is more effective than placebo at improving the symptoms of atopic dermatitis. It has not been directly compared in a clinical trial with standard treatments. But indirect comparisons with JAK inhibitors and biological medicines suggest that it is broadly likely to work as well as these.
The cost-effectiveness estimates for lebrikizumab are within the range that NICE normally considers an acceptable use of NHS resources when compared with other biological medicines (dupilumab or tralokinumab), but not when compared with JAK inhibitors. So, lebrikizumab is only recommended when dupilumab or tralokinumab would otherwise be offered.