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  • Question on Consultation

    Are there any aspects of the recommendations that need particular consideration to ensure we avoid unlawful discrimination against any group of people on the grounds of race, gender, disability, religion or belief, sexual orientation, age, gender reassignment, pregnancy and maternity?

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    Has all of the relevant evidence been taken into account?

  • Question on Consultation

    Are the summaries of clinical and and cost effectiveness reasonable interpretations of the evidence?

  • Question on Consultation

    Are the recommendations sound and a suitable basis for guidance to the NHS?
The content on this page is not current guidance and is only for the purposes of the consultation process.

1 Recommendations

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1 Recommendations

1.1 Dupilumab is not recommended, within its marketing authorisation, for treating moderate to severe prurigo nodularis in adults when systemic treatment is suitable.

1.2 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 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 there are several concerns with the model, including:

  • the different utility values applied for dupilumab and best supportive care at the start of treatment for people whose condition has not responded

  • the way loss of treatment response is modelled for people having best supportive care.

Because of the concerns with the economic model and the uncertain clinical evidence, the cost-effectiveness estimates are highly uncertain. They 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.