NICE improves access to drug treatments for psoriatic arthritis

The National Institute for Health and Clinical Excellence (NICE) has extended the range of drugs that NHS healthcare professionals can prescribe for people who have active and progressive psoriatic arthritis.

In its updated guidance, NICE advises healthcare professionals to prescribe infliximab (Remicade), etanercept (Enbrel) or adalimumab (Humira) if:

• the person has peripheral arthritis with three or more tender joints and three or more swollen joints, and
• the psoriatic arthritis has not responded to adequate trials of at least two standard disease-modifying anti-rheumatic drugs (DMARDs), administered either individually or in combination.
  

The NICE technology appraisal advises healthcare professionals to opt for the least expensive drug first within their healthcare setting, taking into account the associated administration costs, the required dose and its price per dose. This may vary according to individual patients due to differences in administration methods and treatment schedules.

The guidance also recommends that treatment should be discontinued if a person’s disease does not show an adequate response on the Psoriatic Arthritis Response Criteria (PsARC) at 12 weeks.

Healthcare professionals should also consider continuing treatment if a person’s skin disease has a Psoriasis Area and Severity Index (PASI) 75 response at 12 weeks in the absence of an adequate PsARC response. This assessment should be carried out by a dermatologist to determine whether continued treatment is appropriate on the basis of the skin response alone.

Dr Carole Longson, director of the Health Technology Evaluation Centre at NICE said: ‘Psoriatic arthritis is a progressive and painful disease, which can significantly affect a person’s ability to work and carry out day-to-day activities. The impact of severe psoriasis on a person’s quality of life is considered to be similar to that of other major medical conditions, like diabetes or heart disease.

‘The aim of treatment is to relieve the symptoms, delay the progression of the disease and maintain quality of life for as long as possible. We are confident that etanercept, infliximab and adalimumab can do this for certain patients; and so are pleased that all these drugs can be recommended as options for people who have psoriatic arthritis.’

The final guidance replaces and updates two technology appraisals published by NICE in 2006 and 2007.

For more information

• read the full guidance Psoriatic arthritis – etanercept, infliximab and adalimumab
  
• see our factsheet on Biologics drugs for arthritis factsheet
  

If you would like to talk to someone about your arthritis, call Arthritis Care’s free helpline in confidence on 0808 800 4050 Monday to Friday (10am-4pm). Alternatively, you can email Helplines@arthritiscare.org.uk