Adalimumab for the treatment of adults with psoriasis

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.

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 5-point reduction in DLQI from start of treatment.

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.