1.1 Baricitinib 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 systemic immunosuppressant, such as ciclosporin, methotrexate, azathioprine and mycophenolate mofetil, or these are not suitable, and
the company provides it according to the commercial arrangement.
1.2 Assess response from 8 weeks and stop baricitinib if there has not been an adequate response at 16 weeks, defined as a reduction of at least:
50% in the Eczema Area and Severity Index score (EASI 50) from when treatment started and
4 points in the Dermatology Life Quality Index (DLQI) from when treatment started.
1.3 When using the EASI, take into account skin colour and how this could affect the EASI score, and make appropriate clinical adjustments.
1.4 When using the DLQI, take into account any physical, psychological, sensory or learning disabilities, or communication difficulties that could affect the responses to the DLQI, and make any appropriate adjustments.
1.5 These recommendations are not intended to affect treatment with baricitinib 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
People with moderate to severe atopic dermatitis that has not responded to at least 1 systemic immunosuppressant are usually offered either dupilumab or best supportive care. Dupilumab does not always work, and some people stop taking it because of side effects. Baricitinib is an alternative to dupilumab and best supportive care. It is likely to be offered alongside topical corticosteroids.
Clinical trial results show that baricitinib reduces the severity and symptoms of atopic dermatitis compared with placebo. Baricitinib has not been directly compared with dupilumab. The results of an indirect comparison suggest that baricitinib is less effective than dupilumab.
The most likely cost-effectiveness estimates for baricitinib are within what NICE considers an acceptable use of NHS resources. Therefore, baricitinib is recommended as an option for moderate to severe atopic dermatitis when at least 1 systemic immunosuppressant has not worked or is not suitable.