Limited coverage criteria – delgocitinib

Generic name

delgocitinib

Strength & form

20 mg/g topical cream

Initial

For the treatment of moderate to severe chronic hand eczema in adult patients (≥ 18 years of age) when ALL of the following criteria are met:

• Patient is refractory to an adequate 8-week trial of high- to super-high¹ potency topical corticosteroids, or has documented intolerance to, or is contraindicated for, high- to super-high potency topical corticosteroids 

AND

• Patient has a Physician Global Assessment (PGA) score of ≥ 3, indicating moderate to severe disease

AND

• The Special Authority request is submitted by a dermatologist

24 weeks

Renewal

Renewal will be considered for patients who achieve a ≥ two-point improvement in PGA score, or a PGA score of 0 to one ("clear/almost clear"), when the Special Authority request is submitted by a dermatologist.