Atopic dermatitis drug gets PBAC support

Abrocitinib is a cost-effective alternative for severe AD, the committee says.

The PBAC has recommended the general schedule listing of abrocitinib tablets for adult patients with chronic severe atopic dermatitis.

There is a clinical need for additional systemic treatments for severe AD, and abrocitinib 200mg provides similar efficacy but potentially inferior safety compared to dupilumab, the PBAC said in an outcomes statement from its November meeting.

“There was a possible minor added benefit for abrocitinib 200mg compared with dupilumab in terms of faster onset of response and … this benefit was offset by an increase in treatment related adverse events.”

The PBAC said there that while abrocitinib 100mg had an inferior clinical benefit to dupilumab, it may have a place for patients who did not respond to other systemic treatments and cannot have the higher dose for safety reasons, and for patients who want to down-titrate to the lowest effective dose.

As for the 50mg dose, the PBAC said the cost-effectiveness would be acceptable if it was listed at the same price per milligram as abrocitinib 100mg.

“The 50mg dose is recommended for patients with moderate to severe renal impairment, or for those taking strong inhibitors of cytochrome P450 (CYP) 2C19.”

Staff specialist dermatologist at Sydney’s Liverpool Hospital, Associate Professor John Frew, said abrocitinib was “a useful addition to the armamentarium of therapies for AD in Australia.”

Baricitinib provided another alternative option for moderate to severe atopic dermatitis as another member of the JAK inhibitor family, he said.

Professor Frew said data from the JADE phase 3 program showed that abrocitinib had a rapid onset of action and high level of efficacy, with eczema area and severity index 75 and 90 rates.

A 2023 network meta-analysis ranked abrocitinib 200mg and upadacitinib 30mg as the top two most effective agents for moderate to severe AD, he said.

“Whilst direct comparison is difficult in the absence of head-to-head trials, commentary has been made that abrocitinib may demonstrate slightly less adverse events than ipadacitinib but increased reports of nausea.”