NICE accepts two drugs for severe plaque psoriasis
Plaque psoriasis: discontinue treatment if response is inadequate |
Etanercept (Enbrel) and efalizumab (Raptiva) have been recommended for the treatment of severe plaque psoriasis by the National Institute for Health and Clinical Excellence.
Etanercept has been accepted for the treatment of adults with plaque
psoriasis, only when the disease is severe (defined as a total psoriasis
area severity index [PASI] of 10 or more and a dermatology life quality
index [DLQI] of more than 10). In addition, a patient must have failed
to respond to standard systemic therapies or a patient is intolerant
to, or has a contraindication to, standard systemic therapies. Efalizumab
is also recommended for severe plaque psoriasis, but only if a patient
has failed to respond to etanercept or is intolerant to, or has a contraindication
to, etanercept.
After 12 weeks, treatment with either drug should be discontinued if
there has not been an adequate response — defined as a 75 per cent
reduction in PASI or a 50 per cent reduction in PASI together with a
five-point reduction in DLQI.
NICE has also recommended etanercept and infliximab for the treatment
of adults with severe psoriatic arthritis. Etanercept is recommended
for patients who have peripheral arthritis which has not responded to
at least two standard disease-modifying anti-rheumatic drugs and have
three or more tender joints and three or more swollen joints. Infliximab
is only recommended for these patients if the patient is intolerant to,
or has contraindications to, treatment with etanercept or has major difficulties
with self-administering injections.
Treatment with etanercept or infliximab should be discontinued if there
has not, after 12 weeks, been an improvement in at least two of the four
psoriatic arthritis response criteria, one of which has to be joint tenderness
of swelling score, with no worsening in any of the four criteria.
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