New Data Show Delgocitinib Cream Effective in CHE Before and After Systemic Therapy

New data presented at the 2026 American Academy of Dermatology Annual Meeting in Denver suggest that delgocitinib cream 20 mg/g (Anzupgo; LEO Pharma) delivers meaningful clinical benefit for adults with moderate to severe chronic hand eczema (CHE), whether or not they have previously been treated with systemic therapies. The findings, drawn from a pooled post hoc analysis of the phase 3 DELTA 1 and DELTA 2 trials, add to the growing evidence base supporting the agent's role in a condition that has historically posed significant treatment challenges.^1,2

Background and Study Design

CHE is a persistent inflammatory condition that meaningfully affects quality of life and occupational function. For patients who do not respond adequately to topical corticosteroids (TCS), the standard next step has traditionally been systemic therapy — including oral retinoids, corticosteroids, methotrexate, and cyclosporine — all of which carry tolerability and safety limitations with long-term use. Delgocitinib cream, a non-steroidal topical pan-JAK inhibitor, has received regulatory approval in the United States and Europe for moderate to severe CHE in adults for whom TCS are inadequate or inappropriate.

The current analysis pooled data from the 2 randomized controlled trials, stratifying patients by prior systemic therapy exposure: those who were systemic-naïve and those who were systemic-experienced, defined as having received systemic therapy for more than 28 days prior to study baseline. Efficacy was evaluated at week 16 across four endpoints: IGA-CHE treatment success (IGA-CHE TS), a 75% or greater improvement from baseline in the Hand Eczema Severity Index (HECSI-75), and at least a 4-point improvement in Hand Eczema Symptom Diary (HESD) itch and pain scores.

Patient Characteristics

A total of 960 patients were included in the pooled analysis. Among those who were systemic-naïve, 444 received delgocitinib cream and 233 received cream vehicle. In the systemic-experienced group, 195 received delgocitinib cream and 88 received vehicle. Oral retinoids and corticosteroids were the most commonly reported prior systemic therapies across both treatment groups. Notably, a higher proportion of systemic-experienced patients in the delgocitinib arm had severe disease at baseline compared with their vehicle-arm counterparts (34.9% vs 25.0%), a baseline imbalance that is relevant when interpreting comparative outcomes in that subgroup.

Efficacy Results

Across all 4 efficacy measures, delgocitinib cream outperformed cream vehicle at week 16, with statistically significant differences observed in both subgroups (all P<0.05 or better). Response rates favored the active treatment from earlier timepoints, and improvements were generally more pronounced in systemic-naïve patients — a pattern the authors describe as consistent across the full 16-week observation period.

The forest plot of week 16 responder differences confirmed that estimates consistently favored delgocitinib cream over vehicle for both naïve and experienced patients, with no overlap into the favoring-vehicle range for any efficacy endpoint. P-values for all comparisons fell at or below 0.002, providing a robust statistical signal despite the more heterogeneous and numerically smaller systemic-experienced cohort.

Clinical Implications

The authors note that the favorable performance in systemic-naïve patients has practical positioning implications. If delgocitinib cream can achieve clinically meaningful outcomes in patients who have not yet tried systemic therapy, this raises the question of whether it might serve as a topical bridge — or even an alternative — before escalation to agents carrying greater systemic risk. The analysis also demonstrates that prior systemic exposure does not negate the benefit of the treatment, which is relevant for the many patients in clinical practice who arrive with a history of partial or inadequate responses to systemic agents.

These findings should be interpreted in the context of the post hoc, non-randomized nature of the subgroup analysis, which limits the strength of causal inference regarding treatment-by-subgroup interaction. The baseline imbalance in disease severity between delgocitinib and vehicle arms in the systemic-experienced group warrants particular attention.

Delgocitinib cream is currently approved by both the FDA and the European Medicines Agency for adults with moderate to severe CHE for whom TCS are inadequate or inappropriate.

References

1. Bissonnette R, Schliemann S, Worm M, et al. Delgocitinib cream 20 mg/g for moderate to severe Chronic Hand Eczema: outcomes over 16 weeks by prior systemic therapy exposure. Poster presented at the 2026 American Academy of Dermatology Annual Meeting. Denver, Colorado. March 27-31, 2026. https://eposters.aad.org/s3/AM2026/poster/72824/Delgocitinib+cream+20+mgg+for+moderate+to+severe+Chronic+Hand+Eczema+outcomes+over+16+weeks+by+prior+systemic+therapy+exposure.pdf
2. Bissonnette R, Warren RB, Pinter A, et al. Efficacy and safety of delgocitinib cream in adults with moderate to severe chronic hand eczema (DELTA 1 and DELTA 2): results from multicentre, randomised, controlled, double-blind, phase 3 trials. Lancet. 2024;404(10451):461-473. doi:10.1016/S0140-6736(24)01027-4