Etanercept and efalizumab for the treatment of adults with psoriasis

Etanercept, within its licensed indications, administered at a dose not exceeding 25 mg twice weekly is recommended for the treatment of adults with plaque psoriasis only when the following criteria are 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 failed to respond to standard systemic therapies including ciclosporin, methotrexate and PUVA (psoralen and long-wave ultraviolet radiation); or the person is intolerant to, or has a contraindication to, these treatments.

Etanercept treatment should be discontinued in patients whose psoriasis has not responded adequately at 12 weeks. Further treatment cycles are not recommended in these patients. An adequate response is defined as either:

• a 75% reduction in the PASI score from when treatment started (PASI 75) or

• a 50% reduction in the PASI score (PASI 50) and a 5-point reduction in DLQI from when treatment started.

It is recommended that the use of etanercept for psoriasis should be initiated and supervised only by specialist physicians experienced in the diagnosis and treatment of psoriasis. If a person has both psoriasis and psoriatic arthritis their treatment should be managed by collaboration between a rheumatologist and a dermatologist.

NICE has withdrawn its guidance on the use of efalizumab for the treatment of adults with psoriasis because the EMEA's Committee for Medicinal Products for Human Use has reviewed possible links between the drug and a rare but deadly brain infection and said the benefits of efalizumab no longer outweigh its risks, because of safety concerns, notably the occurrence of progressive multifocal leukoencephalopathy.