Interventions of Interest:
- abrocitinib (Pfizer)
- tralokinumab (LEO Pharma)
- baricitinib (Olumiant®, Eli Lilly, Incyte Corporation)
- upadacitinib (Rinvoq®, AbbVie)
- ruxolitinib (Opzelura™, Incyte Corporation)
Atopic dermatitis is a chronic relapsing skin condition associated with dry skin and itching. It is characterized by acute flare-ups of pruritic lesions over dry skin. Atopic dermatitis is a subset of the broad classification of eczema. It is the most common skin disease in children, with 50% of patients experiencing onset of disease within their 1st year of life and 85% before the age of 5.
- Given uncertainty about safety data on oral JAK inhibitors for other indications, a narrow majority of the independent appraisal committee voted that the current evidence is adequate to demonstrate that abrocitinib, baricitinib, and upadacitinib provide a net health benefit.
- Committee found the evidence is adequate to demonstrate that systemic tralokinumab and topical ruxolitinib both provide a net health benefit.
- Policy recommendations highlight rationale for formulary inclusion of at least one biologic and one JAK inhibitor should JAK inhibitors receive marketing approval; importance of diversity of patients in framing options for step therapy; and the shared responsibility to price and cover new therapies in a way that reduces health inequities.
“Both in this review and in our 2017 review, we heard from multiple stakeholders how disruptive severe atopic dermatitis can be for patients and their families, affecting work, school, sleep, mental health, and self-assurance. For many people, atopic dermatitis is a relatively mild condition, but atopic dermatitis can be a severe, chronic disease with significant effects on quality of life. Dupilumab was a major advance, but it does not work for all patients, and new therapies are needed. If they prove safe, JAK inhibitors are likely to benefit many patients, including some who did not get adequate relief with dupilumab. At our public meeting, the New England CEPAC discussed the importance of ensuring these new therapies for atopic dermatitis improve the health of patients and families and do not aggravate existing health inequities. Clinical experts and patients highlighted that the high cost of new therapies might worsen disparities in accessing care.”