The pan-Janus kinase (JAK) inhibitor delgocitinib (brand name Anzupgo) has been recommended by the National Institute for Health and Care Excellence (NICE) as a new treatment option for moderate-to-severe chronic hand eczema.
It is the first-and-only topical treatment indicated for adult patients for whom topical corticosteroids are inadequate or inappropriate. NICE estimates that approximately 62,000 patients in England and Wales will be eligible.
The cream will be made available through specialist services, ‘ensuring people receive appropriate clinical oversight from healthcare professionals experienced in diagnosing and treating chronic hand eczema in secondary care’, NICE said in its final technology appraisal guidance, which must be implemented within 90 days.
The guidance also urged clinicians to consider how skin colour may influence the assessment of disease severity and make any adjustments needed.
Delgocitinib works by blocking the activity of four specific JAK enzymes, which helps to reduce skin inflammation, itching and pain and can help to increase a patient’s ability to perform daily activities and improve their quality of life.
It also has a 12-month shelf life once opened, making it easier for people to restart treatment when their symptoms flare up without needing a new hospital appointment, NICE said.
Efficacy of delgocitinib for chronic hand eczema
The pan-JAK inhibitor was approved by the Medicines and Healthcare products Regulatory Agency in December 2024 and subsequently recommended by NICE based on robust clinical evidence from the DELTA 1, 2, 3 and DELTA FORCE trials.
The clinical trials found delgocitinib to be more effective at improving symptoms of chronic hand eczema than alitretinoin or a ‘vehicle cream’.
The NICE committee said while delgocitinib had not been directly compared in a clinical trial with phototherapy, an indirect comparison suggested that delgocitinib was more effective.
NICE said the decision could ‘transform’ the lives of people with a debilitating condition, particularly as current treatments are not effective for some people.
It could also save the NHS money as many patients currently rely on phototherapy sessions, which involve regular visits to hospital. Delgocitinib is likely to need less monitoring than current treatments, which can cause significant side effects, particularly alitretinoin, the committee noted.
The final approval came after the company presented new evidence to NICE’s independent appraisal committee.
Improving quality of life
Professor Richard Warren, clinical senior lecturer and honorary consultant dermatologist at the University of Manchester and Northern Care Alliance NHS Foundation Trust, said: ‘The NICE recommendation marks a pivotal moment in the treatment of moderate-to-severe chronic hand eczema in the United Kingdom. There have been limited treatment options for these patients. This recommendation provides a new, evidence-based option – an important step for patients living with what can be a debilitating disease.’
Leanne Walsh, vice president and general manager at delgocitinib manufacturer LEO Pharma UK and Ireland, commented: ‘What’s especially encouraging is how NICE has recognised the need for equitable care, including how this condition shows up differently across skin tones. It’s a real step forward.’
Andrew Proctor, chief executive of the National Eczema Society, said: ‘We use our hands all the time, whether it’s texting, operating machinery, caring for others or simply going about daily life.
‘Yet for many people living with chronic hand eczema, even routine tasks can become painful and life-limiting.
‘NICE’s positive recommendation of delgocitinib is a brilliant outcome outcome for the eczema community in the UK who struggle so badly with chronic hand eczema.’
A recent report examines adherence to guidelines for initiating and reviewing biologic and Janus kinase inhibitor therapies, offering valuable insights into real-world prescribing patterns and clinical decision-making in a secondary care dermatology setting.
