1.1
Dupilumab is not recommended, within its marketing authorisation, for treating moderate to severe prurigo nodularis in adults when systemic treatment is suitable.
1 Recommendations
1.2
This recommendation is not intended to affect treatment with dupilumab 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
There is no standard care for prurigo nodularis, but in the NHS, care usually starts with treatments applied to the skin to relieve symptoms. Other treatments are then added as symptoms get more severe. Dupilumab would be used as an alternative for some of these later treatments.
The clinical trial evidence shows that dupilumab improves symptoms of prurigo nodularis compared with best supportive care. But in the trials, this care did not include many of the treatments that are usually used in the NHS. So, the trial results are uncertain and may not be generalisable to the NHS.
The results from the economic analysis are uncertain because of several concerns with the model, including:
that different utility values were applied for dupilumab and for best supportive care after 24 weeks of treatment for people whose condition had not responded
the way that loss of treatment response was modelled for people having best supportive care.
The cost-effectiveness estimates are uncertain because of the concerns about the economic model, and because the clinical evidence is uncertain. The estimates are also above the range that NICE considers to be an acceptable use of NHS resources. So, dupilumab cannot be recommended for routine use in the NHS.