Etanercept should be offered as an option for treating adults with severe plaque psoriasis when:
- other treatments haven't worked (for example, drugs given by injection or orally, that is, by mouth), or
- these other treatments cause a reaction which means that the person shouldn't continue taking them, or
- the person has another condition or uses another medicine that means they should not take these other treatments.
If the person's psoriasis has not shown a measured response to etanercept after 12 weeks, the treatment should be stopped.
The European Medicines Agency (EMEA), the European Union (EU) body which is responsible for monitoring the safety of medicines, has withdrawn the marketing authorisation for MerckSerono's psoriasis drug efalizumab (Raptiva).
The EMEA's Committee for Medicinal Products for Human Use has reviewed possible links between the drug and a rare but deadly brain infection and said the benefits of efalizumab no longer outweigh its risks, because of safety concerns, notably the occurrence of progressive multifocal leukoencephalopathy. As a result the 'British national formulary' has been updated to say that efalizumab should not be prescribed for patients who are not already taking it. Treatment for patients who are taking efalizumab should be reviewed.
Therefore, NICE has withdrawn its guidance on the use of efalizumab for the treatment of adults with psoriasis. Guidance on the use of etanercept for the treatment of adults with psoriasis remains the same and in force.
The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.