Nemolizumab for treating moderate to severe atopic dermatitis in people aged 12 and over or prurigo nodularis in adults [ID6221]

Atopic dermatitis (also known as atopic eczema) is a long-term condition that affects the skin. It is characterised by a blotchy rash dry itchy and inflamed skin. The skin can also ooze and weep. Constant scratching can cause the skin to split and bleed which can cause skin infections. Severe dermatitis can be physically disabling or incapacitating and can cause anxiety or depression.

Atopic dermatitis can affect any part of the body but it most often affects the hands in adults.

Inflamed skin can also be more difficult to see on people with darker skin tones 1*.Estimates of the prevalence of atopic dermatitis vary.

It is more common in childhood (affecting 1 in 5 children in the UK) and affects 1 in 10 adults in the UK.2 Of the people who need treatment for atopic dermatitis 7% will have moderate to severe disease and around 60% of these people will need a systemic treatment rather than an ointment 3*.Atopic dermatitis is usually managed in primary care.

Treatment strategies include advice on the avoidance of factors that can provoke dermatitis such as soap and the use of emollients to moisturise and relieve symptoms.

For flares or dermatitis that does not respond to these measures topical corticosteroids are normally prescribed once or twice daily in conjunction with continued use of emollients as recommended in Technology Appraisal 81.Two calcineurin inhibitors (tacrolimus and pimecrolimus) are recommended as second-line treatment options when the disease has not been adequately controlled by the use of topical corticosteroids at the maximum strength and potency or where there is a serious risk of adverse effects from further topical corticosteroid use particularly irreversible skin atrophy (TA82).

Tacrolimus ointment is recommended for treating moderate to severe atopic dermatitis in people aged 2-years and older while pimecrolimus cream is recommended for treating moderate atopic dermatitis on the face and neck in children aged 2 to 16-years (TA82).

Since the publication of TA82 the marketing authorisation for pimecrolimus cream has been extended to include people aged 3 months and older.

Alitretinoin is recommended as a treatment option for adults with severe chronic hand dermatitis affecting their quality of life and notresponding to potent topical corticosteroids (TA177).

In addition phototherapy andphotochemotherapy (psoralen–ultraviolet A; PUVA) can be used to manage moderate to severe atopic dermatitis in selected adults and older children 4*.People with moderate or severe atopic dermatitis not responding to topical treatments may be referred to secondary care and offered stronger oralmedications such as oral steroids or systemic immunosuppressants (azathioprine ciclosporin mycophenolate mofetil and methotrexate) 5*.Abrocitinib (TA814) and upadacitinib (TA814) are recommended as options for treating moderate to severe atopic dermatitis in adults and young people 12-years and over whose disease has not responded to at least 1 other systemic therapysuch as ciclosporin methotrexate azathioprine and mycophenolate mofetil or these are contraindicated or not tolerated.

Dupilumab (TA534) baricitinib (TA681) and tralokinumab (TA814) are recommended as options for treating moderate to severe atopic dermatitis in adults whose disease has not responded to at least 1 other systemic therapy.

Since the publication ofTA534 and TA814 the marketing authorisations for dupilumab and tralokinumab respectively have been extended to include people aged 12 to 17-years and are commissioned by NHS England for this group.

Lebrikizumab (TA986) is recommended as an option for treating moderate to severe atopic dermatitis in people aged 12-years and older with a body weight of 40 kg or more whose disease has not responded to at least 1 systemic immunosuppressant or if these treatmentsare not suitable and dupilumab or tralokinumab would otherwise be offered.References*1.

NHS Atopic eczema Accessed June 20242. National Eczema Society. Our skin and eczema. Accessed March 20243.

National Institute for Health and Care Excellence (2022) Resource impact report: Abrocitinib tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis (TA814) . Accessed April 2023.4. Simpson EL Bruin-Weller M Flohr C Ardern-Jones MR Barbarot S et al. When does atopic dermatitis warrant systemic therapy?

Recommendations from an expert panel of the International Eczema Council. Journal of the American Academy of Dermatology 2017; 77(4):623-633.5. British Association of Dermatologists (2022) Atopic eczema. Accessed March 2024