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Atopic Eczema — SCE Dermatology MCQ

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HardInflammatory DermatosesAtopic EczemaSCE Dermatology

An adult with severe atopic dermatitis begins dupilumab after ciclosporin intolerance. At week 16, EASI has improved by 58% and DLQI has fallen from 21 to 18. What does NICE TA534 require?

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Correct answer: B — Stop dupilumab because the DLQI component fails the week-16 response rule

Explanation lettering: B = shown as A · C = shown as B · A = shown as C

C is correct. NICE requires both components at week 16: at least EASI 50 and at least a four-point DLQI improvement. The EASI component is met, but DLQI has improved by only three points, so the defined adequate response has not been achieved and treatment should stop. EASI 75 is a common trial endpoint but is not the NICE continuation rule in TA534. Scores must still be interpreted fairly, including adjustment for disabilities, communication difficulty and the effect of skin colour on EASI, but neither component can simply be discarded in routine application of the appraisal.

Reference: NICE TA534: dupilumab for moderate-to-severe atopic dermatitis: https://www.nice.org.uk/guidance/ta534/chapter/1-Recommendations