Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people

Description of the technologies

Adalimumab (Humira, AbbVie) is a fully human immunoglobulin G1 monoclonal antibody that inhibits the activity of tumour necrosis factor alpha (TNF‑alpha).

Etanercept (Enbrel, Pfizer) is a recombinant human TNF‑alpha receptor fusion protein that inhibits the activity of TNF‑alpha. Biosimilars for etanercept are also available.

Ustekinumab (Stelara, Janssen) is a fully human monoclonal antibody that acts as a cytokine inhibitor by targeting interleukin‑12 and interleukin‑23.

Marketing authorisations

Adalimumab has marketing authorisation for treating 'severe chronic plaque psoriasis in children and adolescents from 4 years of age who have an inadequate response to or are inappropriate candidates for topical therapy and phototherapies'.

Etanercept has a marketing authorisation for treating 'chronic severe plaque psoriasis in children and adolescents from the age of 6 years who are inadequately controlled by, or are intolerant to, other systemic therapies or phototherapies'.

Ustekinumab has a marketing authorisation for treating 'moderate to severe plaque psoriasis in adolescent patients from the age of 12 years and older who are inadequately controlled by, or are intolerant to, other systemic therapies or phototherapies'.

Adverse reactions

For full details of adverse reactions and contraindications, see the summary of product characteristics for adalimumab, etanercept and ustekinumab.

Recommended doses and schedules

Adalimumab: subcutaneous; initially 0.8 mg/kg every week (maximum per dose 40 mg) for 2 doses, then 0.8 mg/kg every 2 weeks (maximum per dose 40 mg).

Etanercept: subcutaneous; 0.8 mg/kg up to a maximum of 50 mg weekly for up to 24 weeks.

Ustekinumab: subcutaneous; 0.75 mg/kg for a body weight less than 60 kg; 45 mg for a body weight of between 60 kg and 100 kg; 90 mg for a body weight of above 100 kg at weeks 0 and 4, then every 12 weeks thereafter.

Prices

Costs may vary in different settings because of negotiated procurement discounts. Costs may vary for biosimilars.

The list prices (excluding VAT; 'British national formulary' [BNF] online, March 2017) are: £352.14 for 40 mg adalimumab in a prefilled pen or prefilled syringe or vial for paediatric use; £35.75 for 10 mg etanercept in a vial (with solvent), powder for reconstitution, for injection; £2,147 for 45 mg ustekinumab in a prefilled syringe.