Ustekinumab is recommended as a possible treatment for people with plaque psoriasis if:
- standard assessments show that their psoriasis is severe and is affecting their quality of life and
- their psoriasis has not improved with other treatments including ciclosporin, methotrexate and PUVA (psoralen and long-wave ultraviolet radiation), or they have had side effects with these treatments in the past or there is a medical reason why they should not be given them.
The manufacturer of ustekinumab has agreed to a ‘patient access scheme’ which means that they provide the higher dose needed for people who weigh more than 100 kg at the same total cost as the lower dose for people who weigh 100 kg or less.
Ustekinumab treatment should be stopped if standard assessments show that a person’s psoriasis has not clearly improved after 16 weeks.
When assessing how a person’s psoriasis affects their quality of life, healthcare professionals should take into account any disabilities or difficulties in communicating which might mean that the standard assessments do not provide accurate information.
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.