NICE final draft guidance recommends improved access to psoriatic arthritis treatments
Three treatments for psoriatic arthritis are recommended in final draft guidance published today (11 June) by the National Institute of Health and Clinical Excellence (NICE).
Etanercept (Enbrel), infliximab (Remicade) and adalimumab (Humira) are proposed for treating adults with active and progressive psoriatic arthritis when specified criteria are met. Following the public consultation in March this year on the first draft guidance, this final draft guidance now proposes wider access to infliximab compared to the initial draft recommendations. As infliximab may be less expensive than etanercept and adalimumab in some cases, it is now an option alongside these drugs, instead of being an option only if etanercept and adalimumab can't be used. This appraisal updates and combines the existing NICE guidance on these drugs, originally published in 2006 and 2007.
The final draft guidance recommends etanercept, infliximab and adalimumab where:
- 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 antirheumatic drugs (DMARDs), administered either individually or in combination.
Treatment should normally be started with the least expensive drug (taking into account drug administration costs, required dose and product price per dose) and considering the administration requirements of individual patients.
Psoriatic arthritis can be a disabling disease, having a significant effect on a person's ability to carry out their usual daily activities. The disease is an inflammatory arthritis affecting the joints and connective tissue, and is associated with psoriasis of the skin or nails. It is a progressive disorder, ranging from mild synovitis (inflammation of the tissue lining joints such as the hip or shoulder) to severe progressive erosion of the joints. People with psoriatic arthritis have a 60% higher risk of mortality than the general population and their life expectancy is estimated to be approximately 3 years shorter. Treatments aim to relieve symptoms, maintain quality of life and slow progression of the disease.
Dr Carole Longson, Director of the NICE Health Technology Evaluation Centre, said: “We're pleased to propose improved access to treatments for psoriatic arthritis in this final draft guidance. Following the helpful responses to our public consultation on the first draft guidance, we now intend to recommend a wider range of treatment options for people with psoriatic arthritis.”
This is draft guidance: NICE has not yet issued final guidance to the NHS. Until NICE issues final guidance, NHS bodies should make decisions locally on the funding of specific treatments. Once NICE issues its guidance on a technology it replaces local recommendations across the country.
This page was last updated: 15 June 2010