Adalimumab is recommended as a possible treatment for adults with plaque psoriasis only if:
- their condition is severe and
- their condition has not improved with other treatments such as ciclosporin, methotrexate and PUVA (psoralen and long-wave ultraviolet radiation), or they have had side effects with these in the past or there is a medical reason why they should not be given these treatments.
Adalimumab treatment should be continued beyond 16 weeks only if the psoriasis has clearly improved within this time.
The severity of a person's psoriasis before and during treatment should be assessed by considering the redness, thickness and scaliness of the plaques, the area of the body involved, and how the condition affects the person's quality of life.
When assessing a person's psoriasis, healthcare professionals should take into account any disabilities or difficulties in communicating, which might mean that standard assessments do not provide accurate information about their condition.
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.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.