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Guselkumab for treating active psoriatic arthritis after inadequate response to DMARDs

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1 Recommendations

1.1 Guselkumab, alone or with methotrexate, is not recommended within its marketing authorisation, for treating active psoriatic arthritis in adults whose disease has not responded well enough to previous disease-modifying antirheumatic drug (DMARD) treatment or who cannot tolerate it.

1.2 This recommendation is not intended to affect treatment with guselkumab that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

Why the committee made these recommendations

Guselkumab is a biological DMARD. People with psoriatic arthritis that is not controlled well enough after 2 conventional DMARDs usually have biological DMARDs. Many of these are already recommended by NICE for treating psoriatic arthritis.

Clinical evidence shows that guselkumab is effective for active psoriatic arthritis compared with placebo. But guselkumab has not been compared directly with other biological DMARDs for psoriatic arthritis. The results of an indirect comparison are uncertain, but suggest that guselkumab is as effective as the biological DMARDs secukinumab and ixekizumab.

The cost-effectiveness estimates for guselkumab are higher than what NICE normally considers an acceptable use of NHS resources. Guselkumab is therefore not recommended.