1.1 Adalimumab is recommended as a treatment option for adults with plaque psoriasis for whom anti-tumour necrosis factor (TNF) treatment is being considered and when the following criteria are both met.
The disease is severe as defined by a total Psoriasis Area Severity Index (PASI) of 10 or more and a Dermatology Life Quality Index (DLQI) of more than 10.
The psoriasis has not responded to standard systemic therapies including ciclosporin, methotrexate and PUVA (psoralen and long-wave ultraviolet radiation); or the person is intolerant of, or has a contraindication to, these treatments.
1.2 Adalimumab should be discontinued in people whose psoriasis has not responded adequately at 16 weeks. An adequate response is defined as either:
a 75% reduction in the PASI score (PASI 75) from when treatment started, or
a 50% reduction in the PASI score (PASI 50) and a five-point reduction in DLQI from start of treatment.
1.3 When using the DLQI, healthcare professionals should ensure that when reaching conclusions on the severity of plaque psoriasis they take into account a person's disabilities (such as physical impairments) and linguistic or other communication difficulties. In such cases, healthcare professionals should ensure that their use of the DLQI continues to be a sufficiently accurate measure. The same approach should apply in the context of a decision about whether to continue the use of adalimumab in accordance with section 1.2.