1 Recommendations

1.1

Nemolizumab with topical corticosteroids or calcineurin inhibitors, or both, can be used as an option to treat moderate to severe atopic dermatitis. It can be used in people 12 years and over with a body weight of 30 kg or more when systemic treatment is suitable, only if:

the atopic dermatitis has not responded to at least 1 systemic immunosuppressant, or these treatments are not suitable, and
a biological medicine would otherwise be offered, and
the company provides nemolizumab according to the commercial arrangement.

1.2

Stop nemolizumab after 16 weeks if there has not been an adequate response, defined as a reduction from starting treatment of at least:

50% in the Eczema Area and Severity Index score (EASI 50)
4 points in the Dermatology Life Quality Index (DLQI).

1.3

Consider how skin colour could affect the EASI score and make any clinical adjustments needed.

1.4

Consider any physical, sensory or learning disabilities, or communication difficulties that could affect the responses to the DLQI, and make any clinical adjustments needed.

1.5

This recommendation is not intended to affect treatment with nemolizumab 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 young people, this decision should be made jointly by the healthcare professional, the young person, and their parents or carers.

What this means in practice

Nemolizumab must be funded in the NHS in England for the condition and population in the recommendations, if it considered the most suitable treatment option. Nemolizumab must be funded in England within 90 days of final publication of this guidance.

There is enough evidence to show that nemolizumab 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.

Why the committee made these recommendations

Usual treatment for moderate to severe atopic dermatitis (eczema) includes emollients, corticosteroids and calcineurin inhibitors applied to the skin. If these treatments are not effective, systemic immunosuppressants can be added. If these are also not effective, or are unsuitable, a Janus kinase (JAK) inhibitor or a biological medicine can be used.

For this evaluation, the company asked for nemolizumab to be considered only for people who have had at least 1 systemic immunosuppressant treatment or when these are not suitable. This does not include everyone who it is licensed for.

Clinical trial evidence shows that nemolizumab is more effective than placebo at improving the symptoms of atopic dermatitis. Indirect comparisons with JAK inhibitors and with other biological medicines suggest that nemolizumab may work as well as most of these treatments.

The cost-effectiveness estimates for nemolizumab are within the range that NICE considers an acceptable use of NHS resources when compared with biological medicines, but not when compared with JAK inhibitors. So, nemolizumab can be used when a biological medicine would otherwise be offered.