NICE guidance - etanercept , infliximab and adalimumab for the treatment of adults with psoriatic arthritis

Etanercept, infliximab and adalimumab are recommended for the treatment of adults with active and progressive psoriatic arthritis when the following criteria are met (1)

• 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 antirheumatic drugs (DMARDs), administered either individually or in combination
• etanercept, adalimumab or infliximab treatment should be discontinued in people whose psoriatic arthritis has not shown an adequate response using the Psoriatic Arthritis Response Criteria (PsARC) at 12 weeks
  • an adequate response is defined as an improvement in at least two of the four PsARC criteria (one of which has to be joint tenderness or swelling score) with no worsening in any of the four criteria
  • people whose disease has a Psoriasis Area and Severity Index (PASI) 75 response at 12 weeks but whose PsARC response does not justify continuation of treatment should be assessed by a dermatologist to determine whether continuing treatment is appropriate on the basis of skin response

Etanercept:

• etanercept is a recombinant human tumour necrosis factor (TNF) receptor fusion protein that inhibits the activity of TNF
  • TNF is a cytokine that is released from T lymphocytes; it mediates inflammation and modulates the cellular immune response
  • etanercept is licensed for use in adults with active and progressive PsA that has responded inadequately to previous disease-modifying anti-rheumatic drugs (DMARDs)

Infliximab:

• infliximab is a chimeric monoclonal antibody that binds with high affinity to TNF, thereby neutralising its activity. It is licensed for the treatment of 'active and progressive PsA in patients who have responded inadequately to disease-modifying anti-rheumatic drugs'

Adalimumab

• is the third TNF inhibitor, after infliximab and etanercept, to be approved in the United Kingdom

Notes:

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

Reference:

1. NICE (August 2010). Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis