1 Recommendations

Guidance

1.1 Adalimumab is recommended as an option for treating plaque psoriasis in children and young people aged 4 years or older, only if the disease:

is severe, as defined by a total Psoriasis Area and Severity Index (PASI) of 10 or more and
has not responded to standard systemic therapy, such as ciclosporin, methotrexate or phototherapy, or these options are contraindicated or not tolerated.

1.2 Etanercept is recommended as an option for treating plaque psoriasis in children and young people aged 6 years or older, only if the disease:

is severe, as defined by a total PASI of 10 or more and
has not responded to standard systemic therapy, such as ciclosporin, methotrexate or phototherapy, or these options are contraindicated or not tolerated.

1.3 Ustekinumab is recommended as an option for treating plaque psoriasis in children and young people aged 12 years or older, only if the disease:

is severe, as defined by a total PASI of 10 or more
has not responded to standard systemic therapy, such as ciclosporin, methotrexate or phototherapy, or these options are contraindicated or not tolerated.

1.4 Stop etanercept treatment at 12 weeks, and adalimumab and ustekinumab treatment at 16 weeks, if the psoriasis has not responded adequately. An adequate response is defined as a 75% reduction in the PASI score from the start of treatment.

1.5 The choice of treatment should be made on an individual basis after discussion between the responsible clinician and the patient, or their parents or carers, about the advantages and disadvantages of the treatments available. Where a biosimilar product is available, start treatment with the least expensive option, taking into account administration costs, the dose needed and the product cost per dose.

1.6 When using the PASI, healthcare professionals should take into account skin colour and how this could affect the PASI score, and make the clinical adjustments they consider appropriate.

1.7 These recommendations are not intended to affect treatment with adalimumab, etanercept or ustekinumab that was started in the NHS before this guidance was published. Children and young people having treatment outside these recommendations 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. This decision should be made jointly by the clinician and the child or young person or the child's or young person's parents or carers.