Psoriatic arthritis - etanercept and infliximab

Summary

Etanercept should be offered as an option for treating adults with psoriatic arthritis when:

• the person has arthritis with three or more tender joints and three or more swollen joints
• at least two other disease-modifying anti-rheumatic drugs (DMARDs), given on their own or together, haven’t worked.

Infliximab should be offered as an option for treating adults with psoriatic arthritis if:

• the person meets the criteria in the two bullets above, and
• etanercept causes a reaction which means that the person shouldn't continue taking it, or
• the person has a condition or is taking another medicine that means they should not take etanercept, or
• the person has major difficulty injecting themselves.  

If the person’s psoriatic arthritis has not shown a measured response at 12 weeks, their treatment with etanercept or infliximab should be stopped.

Erratum

Please note that there is a minor discrepancy between the electronic version of the ‘quick reference guide’ (QRG) on the NICE website and the hard copy version that was mailed to the NHS to arrive on Wednesday 26 July. Section 1.3 of the guidance should read as follows:

1.3 Infliximab, within its licensed indications, is recommended for the treatment of adults with severe active psoriatic arthritis if, under the circumstances outlined in section 1.1, treatment with an anti-TNF (tumour necrosis factor) agent is considered appropriate and the person has been shown to be intolerant of, or have contraindications to, treatment with etanercept or has major difficulties with self administered injections.

The electronic version of the QRG that has been published on the NICE website is the correct version. A follow-up mailing to the NHS explaining this error and enclosing a hard copy of the correct version of the QRG will be sent out shortly.

Documents

For healthcare professionals

• TA104 Psoriatic arthritis, etanercept and infliximab - guidance
• TA104 Psoriatic arthritis, etanercept and infliximab - guidance (word)
• TA104 Psoriatic arthritis, etanercept and infliximab - quick reference guide

For patients, carers and the public

• TA104 Psoriatic arthritis, etanercept and infliximab - information for the public
• TA104 Psoriatic arthritis, etanercept and infliximab - information for the public (word)

Background information

• Review Decision - March 2008
• 2006/034 New NICE guidance to help sufferers of psoriasis and psoriatic arthritis
• TA104:Review proposal
• TA104:Review proposal Appendix A

Implementing this guidance

Any further information NICE has produced to help the NHS implement this guideline locally is linked to below:

• TA104 Psoriatic arthritis - etanercept and infliximab: Costing template and report