The Pharmaceutical Journal
Vol 273 No 7315 p306
4 September 2004

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NICE changes tune on eczema drugs

Topical tacrolimus and pimecrolimus have both been approved by the National Institute for Clinical Excellence for use in atopic eczema.

NICE has changed its decision on pimecrolimus, although it still puts restrictions on use of the drug: its preliminary recommendation was that the drug should not be used at all.

As second-line treatments, tacrolimus is recommended as an option for moderate to severe eczema in adults and children aged two years and older and pimecrolimus for moderate eczema on the face and neck in children aged two to 16. For both immunomodulators, NICE recommends use only if the disease is not controlled by topical steroids and where there is a serious risk of side effects, particularly skin atrophy, from further use of steroids.

Tacrolimus and pimecrolimus have similar mechanisms of action but different licensed indications. NICE’s recommendation for tacrolimus is similar to its licensed indications. For pimecrolimus, the recommendation is more restricted because this drug is licensed for mild to moderate eczema in both adults and children, and not only for facial use. However, the recommendation for use of the drug in children has been welcomed by Novartis, manufacturer of Elidel (pimecrolimus).

In Scotland, the Scottish Medicines Consortium has recently announced that pimecrolimus cream is not recommended for NHS use. It says there is no evidence of clinical advantage over alternative treatments, such as mild-to-moderately potent steroids, and that the economic case for using pimecrolimus is unproven. Novartis comments that this decision denies access to a treatment that has been licensed in over 80 countries and recommended by NICE. The SMC recommends restricted use of tacrolimus.

The NICE guidance is available via links on PJ Online (www.pjonline.com/pj/links).