Drugs affecting the immune response for eczema (Formulary)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

ABROCITINIB

Therapy notes

MHRA advice: Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality (April 2023) (www.gov.uk).

Formulation and dosage details

Formulation:

Tablets film-coated 50mg, 100mg and 200mg (hospital use only)

Dosage:

As per SMC 2431: for the treatment of moderate-to-severe atopic dermatitis in adults and adolescents 12 years and older who are candidates for systemic therapy.
SMC restriction: for use in patients who have not responded to, or have lost response to, at least one systemic immunosuppressant therapy, or in whom these are contraindicated or not tolerated.

Homecare is the preferred option - contact nhsh.homecare@nhs.scot

DUPILUMAB

Therapy notes

MHRA advice: Dupilumab (Dupixent): risk of ocular adverse reactions and need for prompt management (November 2022) (www.gov.uk)

  • Dupilumab is for specialist use only (Dermatology Consultant or Specialist Nurse) for patients with moderate to severe eczema not adequately controlled with topical therapies, and who have had an inadequate response, or contra-indications to phototherapy or standard systemic immunosuppressants eg methotrexate, azathioprine, ciclosporin.
  • Dermatology will perform clinical monitoring every 3 months.
  • National Eczema Society Factsheet on Dupilumab.
    GP will provide patient information booklet.

Formulation and dosage details

Formulation:

Solution for injection pre-filled syringe 300mg (specialist use only)

Dosage:

As per SMC 2232: the treatment of moderate-to-severe atopic dermatitis in adolescents (≥12 to <18 years) who are candidates for systemic therapy.
SMC restriction: patients who have had an inadequate response to existing systemic immunosuppressants such as ciclosporin, or in whom such treatment is considered unsuitable.

and SMC 2011: the treatment of moderate-to-severe atopic dermatitis in adult patients who are candidates for systemic therapy.
SMC restriction: patients who have had an inadequate response to existing systemic immunosuppressants such as ciclosporin, or in whom such treatment is considered unsuitable.

Subcutaneous injection. Initially 600mg, followed by 300mg every 2 weeks, the initial dose should be administered as two consecutive 300mg injections at different injection sites, review treatment if no response after 16 weeks.

Homecare is the preferred option - contact nhsh.homecare@nhs.scot.

TRALOKINUMAB

Therapy notes

Formulation and dosage details

Formulation:

Solution for injection in pre-filled syringe 150mg (specialist initiation only)

Dosage:

Third line. (Second line biologic therapy).

As per SMC 2403: treatment of moderate-to-severe atopic dermatitis in adult patients who are candidates for systemic therapy.
SMC restriction: patients who have had an inadequate response to an existing systemic immunosuppressant such as ciclosporin, or in whom such treatment is considered unsuitable.

UPADACITINIB

Therapy notes

MHRA advice: Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality (April 2023) (www.gov.uk).

Formulation and dosage details

Formulation:

Tablets prolonged-release 15mg, 30mg (hospital use only)

Dosage:

As per SMC 2417: for the treatment of moderate to severe atopic dermatitis in adults and adolescents 12 years and older who are candidates for systemic therapy.
SMC restriction: patients who have had an inadequate response to at least one conventional systemic immunosuppressant such as ciclosporin, or in whom such treatment is considered unsuitable.

Homecare is the preferred option - contact nhsh.homecare@nhs.scot

Notes:

For doses of 30mg patients should be prescribed 1 x 30mg tablet and not 2 x 15mg tablets.  This is a more cost-effective option.

Editorial Information

Document Id: F128