Authors' objectives: The aim of this review is to provide guidance on the use of etanercept and efalizumab for the treatment of adults with psoriasis.

Authors' recommendations: 1 Guidance 1.1 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. 1.2 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 five-point reduction in DLQI from when treatment started. 1.3 Efalizumab, within its licensed indications, is recommended for the treatment of adults with plaque psoriasis under the circumstances detailed in section 1.1 only if their psoriasis has failed to respond to etanercept or they are shown to be intolerant of, or have contraindications to, treatment with etanercept. 1.4 Further treatment with efalizumab is not recommended in patients unless their psoriasis has responded adequately at 12 weeks as defined in section 1.2. 1.5 It is recommended that the use of etanercept and efalizumab 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. 1.6 Patients who have begun a course of treatment with efalizumab at the date of publication of this guidance should have the option of continuing to receive treatment until the patients and their clinicians consider it is appropriate to stop.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.nice.org.uk/page.aspx?o=TA103

Year Published: 2006

URL for published report: https://www.nice.org.uk/guidance/ta103

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: National Institute for Health and Care Excellence

Contact Address: Level 1A, City Tower, Piccadilly Plaza, Manchester, M1 4BT

Contact Name: nice@nice.nhs.uk

Contact Email: nice@nice.nhs.uk

Copyright: National Institute for Health and Clinical Excellence (NICE)