At a glance: NICE guidance boost for psoriasis treatments

The National Institute of Clinical Evidence is offering to boost treatment for sufferers of psoriasis and PsA.

Is this in the form of a NICE recommendation?  NICE last month suggested that Wyeth's Enbrel and Serono's Raptiva should be used to treat psoriasis, with Enbrel again and Schering-Plough's Remicade used for psoriatic arthritis (PsA) sufferers.

What are the major problems with these conditions?
With psoriasis, new skin cells get to the surface before the old ones have died and dropped off, causing raised red patches of skin covered with silvery scales (‘plaques'). PsA is an inflammatory condition closely associated with psoriasis.

So what is the new guidance?
Etanercept (Enbrel) should be offered for treating adults with severe plaque psoriasis when other treatments haven't worked, have bad side effects or when the patient can't take other medicines. Efalizumab (Raptiva) should then be offered for another three months. For PsA, Enbrel should be offered when the person has severe arthritis or when two other drugs haven't worked. Infliximab (Remicade) should be offered after that.

If there is no response after three months, both drugs should be stopped.

Who is handling comms for the brands?
Ketchum handles comms for Enbrel; Packer Forbes Communications promotes Remicade; Serono uses Tonic Life Communications for corporate advice but does not have a UK agency on Raptiva.

But none of these are new drugs?
No, all have been licensed before for these chronic progressive conditions. There are no cures for either, but there is a relatively wide range of treatments for both. Some see this as NICE attempting to rationalise the drugs of choice in what is an expensive treatment area.

Is psoriasis really that much of a problem?
It only affects about two per cent of the population, which could be why dermatology is often seen as the ‘Cinderella' of primary care.

But it is a distressing complaint: in its review, NICE accepts psoriasis has been shown to affect quality of life to an extent similar to the effects of other chronic diseases such as depression, heart attack, hypertension, or type 2 diabetes. Meanwhile, PsA affects an estimated five to seven per cent of psoriasis sufferers, can cause disability and appears to be associated with an increased risk of premature death.

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