It is looking likely that patients with psoriatic arthritis in England and Wales will not be able to get routine access to Celgene’s Otezla on the National Health Service, after cost regulators rejected the drug in draft guidelines.

The National Institute for Health and Care Excellence said it is not recommending use of Otezla (apremilast) in patients who have failed to respond to or are unable to take disease-modifying antirheumatic drug (DMARD) therapy.

Most people whose disease doesn’t respond to these drugs will be treated with a tumour necrosis factor alpha inhibitor (TNF-alpha inhibitor), starting with the lowest-cost drug as recommended in NICE guidance on Amgen’s Enbrel (etanercept), Janssen/MSD’s Remicade (infliximab) and AbbVie’s Humira (adalimumab).

While Otezla was found to be effective compared with a placebo, compared with TNF-alpha inhibitors it was the least clinically effective for treating psoriatic arthritis, NICE said, although it did concede that some costs were saved by the drug’s use.

But “there was not enough robust evidence demonstrating that apremilast slows progression of the disease compared to TNF-alpha inhibitors,” and “the costs saved were not sufficient to justify the health losses,” explained Carole Longson, Director of the NICE Centre for Health Technology Evaluation.

Last month NICE said that it was minded not to recommend Otezla for chronic plaque psoriasis, on grounds that its cost failed to fall within the range considered to be a cost-effective use of NHS resources. A final decision for this indication is expected in late September.