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New HTA Decisions in England
March 2021
Drug name
OLUMIANT® (baricitinib)
Eli Lilly
Decision date
Therapeutic area
Skin conditions
Therapeutic sub area
Recommended with restrictions
Baricitinib is recommended as an option for treating moderate to severe atopic dermatitis in adults.
Decision Detail
It is recommended 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 (there is a simple discount patient access scheme for baricitinib). 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. When using the EASI, take into account skin colour and how this could affect the EASI score, and make appropriate clinical adjustments. 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.
JAIN (BREEZE-AD4) and JAIY (BREEZE-AD7) provided the key clinical evidence for baricitinib, both were randomised double blind trials including patients who had moderate to severe atopic dermatitis for at least 12 months. Clinical trial results show that baricitinib reduces the severity and symptoms of atopic dermatitis compared with placebo. There was no direct evidence comparing baricitinib with dupilumab for atopic dermatitis. An indirect treatment comparison suggests that baricitinib is less effective than dupilumab. The committee noted that there was considerable uncertainty around the loss of quality-of-life benefit over time for patients having best supportive care, which had a large impact on the ICERs. However, in the scenarios with the committee's preferred assumptions and quality-of-life waning on best supportive care, the pairwise ICERs suggested that baricitinib was cost effective compared with both dupilumab and best supportive care. Incremental analyses supported the cost effectiveness of baricitinib when used before or after dupilumab, despite uncertainty. The committee concluded that baricitinib is a cost-effective use of NHS resources and could be recommended as an option for people with moderate to severe atopic dermatitis when at least 1 systemic immunosuppressant has not worked or is not suitable.