Apremilast for treating moderate to severe plaque psoriasis

Apremilast is recommended as an option for treating plaque psoriasis in adults, only when the condition:

• is severe, as defined by a total Psoriasis Area Severity Index (PASI) of 10 or more and a Dermatology Life Quality Index (DLQI) of more than 10, and

• has not responded to conventional systemic treatments and phototherapy, or these options are contraindicated or not tolerated, and

• the company provides apremilast with the discount agreed in the patient access scheme.

Stop apremilast treatment if the psoriasis has not responded adequately at 16 weeks. An adequate response is defined as:

• a 75% reduction in the PASI score (PASI 75) from when treatment started, or

• a 50% reduction in the PASI score (PASI 50) and a 5‑point reduction in DLQI from start of treatment

When using the DLQI, healthcare professionals should take into account any physical, sensory or learning disabilities, or communication difficulties, that could affect the responses to the DLQI and make any adjustments they consider appropriate.

This guidance is not intended to affect the position of patients whose treatment with apremilast was started within the NHS before this guidance was published. Treatment of those patients may continue without change to whatever funding arrangements were in place for them before this guidance was published until they and their NHS clinician consider it appropriate to stop.