NICE Draft Guidance Proposes Treatment Options For Psoriatic Arthritis

The National Institute for Health and Clinical Excellence (NICE) has published draft guidance recommending etanercept (Enbrel, Wyeth Pharmaceuticals) and adalimumab (Humira, Abbott Laboratories) for the treatment of adults with active and progressive psoriatic arthritis when specific criteria are met. Infliximab (Remicade, Schering-Plough) is also recommended where neither etanercept nor adalimumab can be used.


In today's draft guidance, which combines and confirms NICE's current guidance on this condition, published in 2006 and 2007, etanercept and adalimumab are recommended for the treatment of adults with active and progressive psoriatic arthritis when:


The person has peripheral arthritis with three or more tender joints and three or more swollen joints The psoriatic arthritis has not responded to adequate trials of at least two standard disease-modifying anti-rheumatic drugs (DMARDs), administered either individually or in combination.Infliximab is recommended for the treatment of adults with active and progressive psoriatic arthritis only if these same criteria are met, and the person is intolerant of, or has contraindications to, etanercept and adalimumab, or they have major problems injecting themselves with these medications.


Psoriatic arthritis is an inflammatory arthritis affecting the joints and connective tissue. It is associated with psoriasis of the skin or nails and is a progressive disorder, ranging from mild synovitis (inflammation of the tissue lining joints such as the hip or shoulder) to severe progressive erosion of the joints. At least 20% of people with psoriasis have severe psoriatic arthritis with progressive joint damage. People with psoriatic arthritis have a 60% higher risk of mortality than the general population and their life expectancy is estimated to be approximately 3 years shorter.


Dr Carole Longson, NICE, said: "Psoriatic arthritis can affect people's ability to work and carry out their usual daily activities. The aim of psoriatic arthritis treatment is to relieve symptoms, slow disease progression and maintain quality of life. In updating our existing guidance on treating psoriatic arthritis, we have included adalimumab as an option alongside etanercept, in specific circumstances. Infliximab remains an alternative option for people unable to use etanercept or adalimumab. We hope that these draft recommendations will help in the management of this disabling disease."


This draft guidance has been issued for consultation: NICE has not yet issued final guidance to the NHS.


NICE's preliminary recommendations are available for public consultation from 15 March 2010 until 8 April 2010. Comments received during this consultation will be considered by the committee and following this meeting the next draft guidance will be issued.


Until NICE issues final guidance, NHS bodies should make decisions locally on the funding of specific treatments. Once NICE issues its guidance on a technology it replaces local recommendations across the country.

Source
NICE


View drug information on Enbrel; Humira; Remicade.