UK Clinicians Gain First NICE-Approved CHE JAK Inhibitor

The therapeutic landscape for chronic hand eczema (CHE) has taken a decisive step forward. The National Institute for Health and Care Excellence (NICE) has issued Technology Appraisal Guidance (TAG) recommending delgocitinib (Anzupgo; Leo Pharma) cream for reimbursement in adult patients with moderate to severe CHE when topical corticosteroids prove inadequate or inappropriate. With this recommendation, delgocitinib becomes the first approved topical pan-Janus kinase (JAK) inhibitor for this indication in England and Wales.¹

Expanding the Armamentarium

For clinicians managing refractory or severe CHE, the options have long been limited. Topical corticosteroids remain first-line, yet concerns over tachyphylaxis, barrier compromise, and adverse effects in long-term use often leave clinicians navigating between suboptimal control and systemic immunosuppression.² Delgocitinib’s approval introduces a new, targeted approach at the topical level, addressing immune dysregulation without systemic exposure.

“The NICE recommendation marks a pivotal moment in the treatment of moderate to severe chronic hand eczema in the United Kingdom,” commented Richard Warren, BSc, MBChB, MRCP, PhD, of The University of Manchester and Northern Care Alliance NHS Foundation Trust, in a news release. “This recommendation provides a new, evidence-based option—an important step for patients living with what can be a debilitating disease.”

Mechanistic Precision

Delgocitinib is a topical pan-JAK inhibitor that blocks multiple Janus kinase pathways, reducing the inflammation that drives chronic hand eczema. By dampening cytokine signaling locally in the skin, delgocitinib aims to reduce inflammation and restore barrier integrity while minimizing systemic absorption.

This mechanism provides a rational, pathophysiology-driven approach for clinicians treating patients in whom conventional topical therapy fails—bridging the gap between emollients and systemic immunomodulators.

Clinical Evidence and the DELTA Program

The NICE decision was supported by data from the DELTA 1, 2, 3, and DELTA FORCE clinical trials. These phase 3 studies demonstrated delgocitinib’s efficacy in improving CHE signs and symptoms versus vehicle, with favorable safety and tolerability profiles. Patients experienced significant improvements in hand eczema severity scores, itch reduction, and overall functional restoration.

Importantly, the DELTA FORCE trial further reinforced these findings under real-world conditions, underscoring sustained benefit and minimal systemic exposure. These results collectively informed NICE’s conclusion that delgocitinib represents an effective, evidence-based intervention for adults with moderate to severe CHE.

Implementation and Clinical Considerations

NICE advises that delgocitinib cream should be initiated and monitored by health care professionals experienced in diagnosing and managing CHE in secondary care. Clinicians are also encouraged to consider how variations in skin color may influence disease assessment, ensuring equitable evaluation and treatment across diverse patient populations.

The formulation offers a steroid-free option for patients where topical corticosteroids are unsuitable due to intolerance, adverse effects, or contraindications. Its topical route and mechanism make it a compelling choice for dermatologists aiming to control inflammation while supporting skin barrier recovery.

A Milestone for Equitable Care

LEO Pharma’s vice president and general manager for the UK and Ireland, Leanne Walsh, highlighted NICE’s recognition of the importance of equitable care in dermatology:

“Delgocitinib is now the first NICE-approved topical treatment of its kind. 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.”

This acknowledgment aligns with the growing emphasis on inclusive dermatologic assessment—particularly relevant in inflammatory dermatoses where erythema or scaling may present variably.

Global Regulatory Momentum

The NICE decision follows a wave of international regulatory endorsements: European Medicines Agency (EMA) approval in September 2024, UK MHRA approval in November 2024, and U.S. FDA approval in July 2025. This sequence underscores both the robustness of delgocitinib’s evidence base and the global recognition of its clinical value.

Implications for Practice

For dermatology clinicians, delgocitinib’s reimbursement recommendation represents more than a new topical agent, it signals a shift toward molecularly targeted, non-steroidal topical therapies in chronic inflammatory dermatoses. Its availability expands the therapeutic continuum for CHE, potentially altering treatment algorithms and improving long-term patient outcomes.

As NICE’s endorsement takes effect, clinicians across the UK now have access to a novel topical option—one that merges scientific precision with practical relevance for patients long underserved by existing therapies.

References

1. LEO Pharma announces NICE recommendation of reimbursement in England and Wales. News release. Leo Pharma. Published November 5, 2025. Accessed November 5, 2025. https://www.leo-pharma.com/media-center/news/2025-nice-recommendation
2. Balato A, Tancredi V, Aerts O, et al. Chronic hand eczema: Common questions and practical recommendations from the EADV Contact Dermatitis Task Force. J Eur Acad Dermatol Venereol. Published online September 29, 2025. doi:10.1111/jdv.70068