13.5.3 Drugs affecting the immune response

Drugs which affect the immune response in skin conditions, listed elsewhere in the formulary:

Pimecrolimus
  • Cream 1% (£19.69 = 30g)

Indications

  • Short-term treatment of mild to moderate atopic eczema (including flares) when topical corticosteroids cannot be used

Dose

  • Short-term treatment: Apply twice daily until symptoms resolve (stop if eczema worsens or no response after 6 weeks). Reduce to once daily if symptoms allow.
  • It may be used for intermittent long term treatment.

Notes

  1. It may be used for intermittent long-term treatment
  2. Emollients may be applied immediately after using pimecrolimus
  3. NICE TA82: Tacrolimus and pimecrolimus for atopic eczema (August 2004):
    1. Topical pimecrolimus (Elidel) is recommended as an option for the second-line treatment of moderate atopic eczema on the face and neck in children aged 2 to 16 years that has not been controlled by topical corticosteroids, where there is a serious risk of important adverse effects from further topical corticosteroid use, particularly irreversible skin atrophy
    2. Topical pimecrolimus (Elidel) is not recommended for the treatment of mild atopic eczema or as first-line treatments for atopic eczema of any severity
Tacrolimus
  • Ointment 0.1% (adults and child over 16 years) (£19.95 = 30g)
  • Ointment 0.03% (child aged 2 to 16 years) (£23.33 = 30g)

Indications

Dose

  • Short-term treatment: Apply twice daily until lesions clear (stop if eczema worsens or no response after 2 weeks). Reduce to once daily if symptoms allow. In children, only the 0.03% strength of topical tacrolimus should be used.
  • Prevention of flares: Apply twice weekly (see BNF). Use short-term treatment regimen during an acute flare.

Notes

  1. NICE TA82: Tacrolimus and pimecrolimus for atopic eczema (August 2004):
    1. Topical tacrolimus (Protopic) is recommended as an option for the second-line treatment of moderate to severe atopic eczema in adults and children aged 2 years and older that has not been controlled by topical corticosteroids, where there is a serious risk of important adverse effects from further topical corticosteroid use, particularly irreversible skin atrophy
    2. Topical tacrolimus (Protopic) is not recommended for the treatment of mild atopic eczema or as first-line treatments for atopic eczema of any severity
  2. MHRA Drug Safety Update (June 2012): Tacrolimus ointment (Protopic): possible risk of malignancies including lymphomas and skin cancers

Cytokine modulators

Bimekizumab
  • Solution for injection in pre-filled pens 160mg

Notes

  1. NICE TA723: Bimekizumab (Bimzelx) is recommended as an option for treating plaque psoriasis in adults (September 2021), only if:
    1. the disease is severe, as defined by a total Psoriasis Area and Severity Index (PASI) of 10 or more and a Dermatology Life Quality Index (DLQI) of more than 10 and
    2. the disease has not responded to other systemic treatments, including ciclosporin, methotrexate and phototherapy, or these options are contraindicated or not tolerated and
    3. the company provides the drug according to the commercial arrangement
    4. refer to TA723 for stopping criteria and other considerations
Brodalumab
  • Solution for injection in pre-filled syringe 210mg in 1.5ml

Notes

  1. NICE TA511: Brodalumab (Kyntheum) isrecommended as an option for treating plaque psoriasis in adults, only when the criteria of the NICE TA are met (March 2018)
Dupilumab
  • Solution for injection 150mg in 1ml

Notes

  1. NICE TA534: Dupilumab (Dupixent) is recommended as an option for treating moderate to severe atopic dermatitis in adults, only when the criteria of the NICE TA are met (August 2018)
Guselkumab
  • Solution for injection 100mg in 1ml

Notes

  1. NICE TA521: Guselkumab (Tremfya) is recommended as an option for treating plaque psoriasis in adults, only when the criteria of the NICE TA are met (June 2018)
  2. NICE TA711: Guselkumab (Tremfya), alone or with methotrexate, is recommended as an option for treating active psoriatic arthritis in adults whose disease has not responded well enough to disease-modifying antirheumatic drugs (DMARDs) or who cannot tolerate them (June 2021), only if they have:
    1. peripheral arthritis with 3 or more tender joints and 3 or more swollen joints
    2. moderate to severe psoriasis (a body surface area of at least 3% affected by plaque psoriasis and a Psoriasis Area and Severity Index [PASI] score greater than 10)
    3. had 2 conventional DMARDs and at least 1 biological DMARD
    4. Guselkumab is recommended only if the company provides it according to the commercial arrangement
    5. refer to TA711 for stopping criteria and other considerations
    Ixekizumab
    • Solution for injection prefilled pen or prefilled syringes 80mg in 1ml

    Notes

    1. NICE TA442: Ixekizumab (Taltz) is recommended as an option for treating plaque psoriasis in adults, only when the criteria of the NICE TA are met (April 2017)
    2. NICE TA537: Ixekizumab (Taltz) alone, or with methotrexate, is recommended as an option for treating active psoriatic arthritis in adults, only when the criteria of the NICE TA are met (August 2018)
    3. NICE TA718: Ixekizumab (Taltz) is recommended as an option for treating active ankylosing spondylitis that is not controlled well enough with conventional therapy, or active non-radiographic axial spondyloarthritis with objective signs of inflammation (shown by elevated C-reactive protein or MRI) that is not controlled well enough with non-steroidal anti-inflammatory drugs (NSAIDs), in adults (July 2021). It is recommended only if:
      1. tumour necrosis factor (TNF)-alpha inhibitors are not suitable or do not control the condition well enough, and
      2. the company provides ixekizumab according to the commercial arrangement.
      3. Refer to TA718 for continuation criteria and other considerations
    Risankizumab
    • Solution for injection pre-filled syringes 150mg in 1ml

    Notes

    1. NICE TA596: Risankizumab (Skyrizi) is recommended as an option for treating plaque psoriasis in adults only when the criteria of the NICE TA are met (August 2019)
    Tildrakizumab
    • Solution for injection pre-filled syringes 100mg in 1ml

    Notes

    1. NICE TA575: Tildrakizumab (Ilumetri) is recommended as an option for treating plaque psoriasis in adults, only when the criteria of the NICE TA are met (April 2019)

    Other preparations

    Fumaderm®

    (Fumaric acid esters)

    • Tablets 105mg, 215mg (unlicensed preparations)
    In hospital use with ultraviolet therapy
    5-methoxy-psoralen
    • Tablets 20mg (unlicensed preparation)
    8-methoxy-psoralen
    • Tablets 10mg (unlicensed preparation)
    • Bath lotion 1.2% (unlicensed preparation)
    • Emulsion 0.15% (unlicensed preparation)
    Last updated: 08-10-2019

     

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