1 Recommendations

Guidance

1.1 Dupilumab is recommended as an option for treating moderate to severe atopic dermatitis in adults, only if:

the disease has not responded to at least 1 other systemic therapy, such as ciclosporin, methotrexate, azathioprine and mycophenolate mofetil, or these are contraindicated or not tolerated
the company provides dupilumab according to the commercial arrangement.

1.2 Stop dupilumab at 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.

1.3 When using the EASI, healthcare professionals should take into account skin colour and how this could affect the EASI score, and make the clinical adjustments they consider appropriate.

1.4 When using the DLQI, healthcare professionals should take into account any physical, psychological, sensory or learning disabilities, or communication difficulties that could affect the responses to the DLQI, and make any adjustments they consider appropriate.

1.5 These recommendations are not intended to affect treatment with dupilumab 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.

Why the committee made these recommendations

Current systemic treatment for moderate to severe atopic dermatitis (eczema) includes ciclosporin, methotrexate, azathioprine and mycophenolate mofetil. Dupilumab would be used after these treatments no longer work, and best supportive care is the only other available option. Dupilumab would likely be offered alongside topical corticosteroids.

The clinical evidence shows that dupilumab is very effective when used in this way. The most plausible cost-effectiveness estimates for dupilumab plus topical corticosteroids compared with best supportive care are within the range that NICE normally considers an acceptable use of NHS resources.