NICE recommends new biological treatment options for plaque psoriasis
In a final appraisal document, NICE has recommended the new biological therapy tildrakizumab (Ilumetri) for the treatment of patients with severe plaque psoriasis.
Tildrakizumab is a monoclonal antibody that selectively binds to the p19 subunit of interleukin (IL)-23, blocking its interaction with the IL-23 receptor, thus inhibiting the release of proinflammatory cytokines and chemokines. It is administered by subcutaneous injection at weeks 0 and 4 and then every 12 weeks thereafter; self-injection is an option from the third or fourth dose onwards.
In its original draft guidance, NICE did not recommend tildrakizumab because it was deemed not to be cost effective compared with other biological therapies. However, following a new NHS price submitted by the company, NICE has now recommended it as a treatment options in adults with severe plaque psoriasis (ie a total Psoriasis Area and Severity Index [PASI] of ≥10 and a Dermatology Life Quality Index [DLQI] of >10), if the disease has not responded to other systemic treatments (including ciclosporin, methotrexate and phototherapy), or if these treatments are contraindicated or not tolerated. Tildrakizumab should be discontinued at 28 weeks if the psoriasis has not responded adequately.
In clinical trials, tildrakizumab improved severe psoriasis more than placebo or the anti-TNF therapy etanercept (which is already recommended by NICE for plaque psoriasis).
In separate final appraisal, NICE has also recommended certolizumab pegol (Cimzia) as a treatment option for severe plaque psoriasis in adults. NICE recommends certolizumab pegol only if the disease is severe and the patient has not responded to, or cannot take, other systemic treatments; the lowest maintenance dosage should be used (ie 200mg every two weeks). The drug should be stopped at 16 weeks if the patient’s psoriasis has not responded adequately.
Certolizumab pegol is an anti-TNF biological therapy that comprises a humanised antibody Fab fragment against TNF conjugated to polyethylene glycol. It has also recently been accepted by the Scottish Medicines Consortium for use in NHS Scotland in patients with moderate to severe plaque psoriasis who have failed to respond to, or cannot take, standard systemic therapies.