Today (25 August), the National Institute for Health and Care Excellence (NICE) has extended the range of drugs that NHS healthcare professionals can prescribe for people who have active and progressive psoriatic arthritis.

In its updated guidance, NICE advises healthcare professionals to prescribe infliximab (Remicade), etanercept (Enbrel) or adalimumab (Humira) if:

• The person has peripheral arthritis with three or more tender joints and three or more swollen joints, and
• 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.

The NICE technology appraisal advises healthcare professionals to opt for the least expensive drug first within their healthcare setting, taking into account the associated administration costs, the required dose and its price per dose. This may vary according to individual patients due to differences in administration methods and treatment schedules.

The guidance also recommends that treatment should be discontinued if a person's disease does not show an adequate response on the Psoriatic Arthritis Response Criteria (PsARC) at 12 weeks. Healthcare professionals should also consider continuing treatment if a person's skin disease has a Psoriasis Area and Severity Index (PASI) 75 response at 12 weeks in the absence of an adequate PsARC response. This assessment should be carried out by a dermatologist to determine whether continued treatment is appropriate on the basis of the skin response alone.

Dr Carole Longson, Director of the Health Technology Evaluation Centre at NICE said: "Psoriatic arthritis is a progressive and painful disease, which can significantly affect a person's ability to work and carry out day-to-day activities. The impact of severe psoriasis on a person's quality of life is considered to be similar to that of other major medical conditions, like diabetes or heart disease.

"The aim of treatment is to relieve the symptoms, delay the progression of the disease and maintain quality of life for as long as possible. We are confident that etanercept, infliximab and adalimumab can do this for certain patients; and so are pleased that all these drugs can be recommended as options for people who have psoriatic arthritis."

The final guidance replaces and updates two technology appraisals published by NICE in 2006 and 2007.

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Notes to Editors

About psoriatic arthritis

1. Psoriatic arthritis is a type of inflammatory arthritis, which is often characterised by pain, stiffness and swelling around the joints - particularly the fingers, toes, wrists, knees and ankles. It is associated with the skin and nail condition psoriasis, which affects up to 3% of the UK population.
2. Up to 30% of people with psoriasis will develop inflammatory arthritis, usually within ten years of their diagnosis.
3. People with psoriatic arthritis have a 60% higher risk of mortality than the general population and their life expectancy is estimated to be approximately three years shorter.

About the NICE technology appraisal

1. View the NICE technology appraisal 199 on the treatment of psoriatic arthritis for further information.
2. Treatment with etanercerpt (Enbrel, Wyeth Pharamceuticals) costs £9295 per year assuming a 50mg once-weekly dose (52 doses per year) or 25mg twice-weekly dose (104 doses per year). Treatment with adalimumab (Humira, Abbot Laboratories) costs £9295 per year, assuming a 40mg dose given every two weeks (26 doses per year). Treatment with infliximab (Remicade, Schering-Plough) for an adult weighing 75kg costs £10,910 (assuming no vial share) per year based on infusions repeated every 8 weeks (average of 6.5 doses per year).
3. Costs for these drugs may vary in different settings because of negotiated procurement discounts.
4. This technology appraisal updates two previous NICE technology appraisals, published in 2006 and 2007. See TA104 (etanercept and infliximab) and TA125 (adalimumab) for more information.

About NICE

1. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

2. NICE produces guidance in three areas of health:

• public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies - guidance on the use of new and existing medicines, treatments, procedures and medical technologies within the NHS
• clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

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