Patients with chronic plaque psoriasis are being prevented from routinely accessing Celgene’s Otezla on the National Health Service in England and Wales, after cost regulators deemed the drug too expensive.

The National Institute for Health Care and Excellence has now issued a Final Appraisal Determination rejecting Otezla (apremilast) because, despite recognising the drug as an innovative step forward in psoriasis treatment, it failed to fall within bounds of what is normally considered value-for-money for the NHS.

Otezla works by reducing the activity of an enzyme called phosphodiesterase known to play a role in the process of inflammation. Unlike current systemic treatments available for psoriasis, it does not require regular lab monitoring, which may help reduce the burden of hospital visits for patients, according to Celgene.

Slamming NICE’s decision, Mark Goodfield, _Consultant Dermatologist at Leeds Teaching Hospitals NHS Trust, said the drug “has the potential to fill an important gap in the treatment pathway,” having “seen first-hand the difference this oral treatment can make, particularly in hard to treat areas such as nails and scalp, and for problem symptoms such as itch”. 

The drug’s continued rejection by NICE for chronic psoriasis and psoriatic arthritis (in separate draft guidelines) will also be particularly galling to patients in England and Wales given that the its use for both indications is funded by NHS Scotland, again highlighting the stark postcode lottery of care that exists across the UK.

In the absence of an appeal or comment on the FAD, final guidance could be issued to the NHS at the end of October.