Psoriasis - efalizumab and etanercept

Etanercept should be offered as an option for treating adults with severe plaque psoriasis when: other treatments haven't worked (for example, drugs given by injection or orally, that is, by mouth), or   these other treatments cause a reaction which means that the person shouldn't continue tak ...

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Etanercept should be offered as an option for treating adults with severe plaque psoriasis when:

• other treatments haven't worked (for example, drugs given by injection or orally, that is, by mouth), or 
•  these other treatments cause a reaction which means that the person shouldn't continue taking them, or
•  the person has another condition or uses another medicine that means they should not take these other treatments.

If the person's psoriasis has not shown a measured response to etanercept after 12 weeks, the treatment should be stopped.

Efalizumab

The European Medicines Agency (EMEA), the European Union (EU) body which is responsible for monitoring the safety of medicines, has recommended that marketing authorisation be suspended for Serono's psoriasis drug efalizumab (raptiva) over possible links between the drug and a rare but deadly brain infection.

The EMEA's Committee for Medicinal Products for Human Use (CHMP) said the benefits of efalizumab no longer outweigh its risks, because of safety concerns, notably the occurrence of progressive multifocal leukoencephalopathy (PML) in patients taking the medicine. The EMEA has advised that patients who are currently taking efalizumab should consult their doctor or pharmacist at a convenient time to discuss their treatment.  The EMEA has advised patients should not stop efalizumab treatment abruptly as this could lead to the disease coming back or getting worse. Their doctor will discuss the most appropriate replacement treatment with them.

As a result of the EMEA's decision, NICE has temporarily withdrawn its guidance on the use of efalizumab for the treatment of adults with psoriasis. Guidance on the use of etanercept for the treatment of adults with psoriasis remains the same and in force. NICE will continue to review the status of its guidance in light of any further changes to efalizumab's marketing authorisation.

Further information on the EMEA's decision is available from its website.

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