1.1 Tofacitinib, with methotrexate, is recommended as an option for treating active psoriatic arthritis in adults, only if:
it is used as described in NICE's technology appraisal guidance on etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis (recommendations 1.1 and 1.2) or
the person has had a tumour necrosis factor (TNF)-alpha inhibitor but their disease has not responded within the first 12 weeks or has stopped responding after 12 weeks or
TNF‑alpha inhibitors are contraindicated but would otherwise be considered (as described in NICE's technology appraisal guidance on etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis).
Tofacitinib is only recommended if the company provides it according to the commercial arrangement.
1.2 Assess the response to tofacitinib after 12 weeks of treatment. Only continue treatment if there is clear evidence of response, defined as an improvement in at least 2 of the 4 Psoriatic Arthritis Response Criteria (PsARC), 1 of which must be joint tenderness or swelling score, with no worsening in any of the 4 criteria. People whose disease has a Psoriasis Area and Severity Index (PASI) 75 response but whose PsARC response does not justify continuing treatment should be assessed by a dermatologist, to determine whether continuing treatment is appropriate based on skin response (as described in NICE's technology appraisal guidance on etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis, recommendation 1.3).
1.3 When using the PsARC healthcare professionals should take into account any physical, sensory or learning disabilities or communication difficulties that could affect a person's responses to components of the PsARC and make any adjustments they consider appropriate.
1.4 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.
1.5 These recommendations are not intended to affect treatment with tofacitinib that was started in the NHS before this guidance was published. 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.
Why the committee made these recommendations
NICE recommends several treatments for treating psoriatic arthritis. Tofacitinib is the first of a new class of drugs for treating psoriatic arthritis (Janus kinase inhibitors).
Clinical trial evidence shows that tofacitinib is more effective than placebo at treating joint and skin symptoms. An indirect comparison suggests that tofacitinib is likely to improve symptoms about as well as some of the current treatments used in the NHS for psoriatic arthritis.
Overall, the cost-effectiveness estimates of tofacitinib are within the range normally considered to be an acceptable use of NHS resources when it is used after 2 conventional disease-modifying anti-rheumatic drugs (DMARDs), or after treatment with a TNF‑alpha inhibitor after 2 conventional DMARDs. Therefore, it can be recommended.