Ruxolitinib cream can be used as an option to treat non-segmental vitiligo with facial involvement in people 12 years and over. Ruxolitinib cream can only be used if:
topical first-line treatments have not worked or are not suitable, and
the company provides it according to the commercial arrangement.
This recommendation is not intended to affect treatment with ruxolitinib cream 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 healthcare professional consider it appropriate to stop. For children or young people, this decision should be made jointly by the healthcare professional, the child or young person, and their parents or carers.
Ruxolitinib cream must be funded in the NHS in England for the condition and population in the recommendations, if it is considered the most suitable treatment option. Ruxolitinib cream must be funded in England within 90 days of final publication of this guidance.
There is enough evidence to show that ruxolitinib cream provides benefits and value for money, so it can be used routinely across the NHS in this population.
NICE has produced tools and resources to support the implementation of this guidance.
This rapid review considers a revised commercial arrangement for ruxolitinib cream for non-segmental vitiligo with facial involvement (NICE technology appraisal guidance 1088).
Usual treatment for non-segmental vitiligo includes off-label treatments that aim to restore the skin's colour (repigmentation). These are corticosteroids and calcineurin inhibitors that are used on the skin (topical treatments). After trying these, some people have treatment with light (phototherapy).
For this evaluation, the company asked for ruxolitinib cream to be considered only after topical first-line treatments. This is narrower than the marketing authorisation for ruxolitinib cream.
Clinical trial evidence shows that ruxolitinib cream increases repigmentation and reduces how noticeable vitiligo patches are compared with a placebo cream. But results of an indirect comparison are too uncertain to show how well ruxolitinib cream works compared with phototherapy.
It is uncertain how accurately the economic model reflects how non-segmental vitiligo is treated in the NHS. It is also uncertain whether treatment with ruxolitinib cream would improve people's quality of life.
Despite these uncertainties in the clinical and economic evidence, the most likely cost-effectiveness estimates are within the range that NICE considers an acceptable use of NHS resources. So, ruxolitinib cream can be used.