The National Institute for Health and Clinical Excellence has this week published draft guidance recommending Wyeth’s Enbrel, Abbott’s Humira and Schering-Plough’s Remicade as treatments for psoriatic arthritis, under certain conditions.

The cost watchdog for therapies used by the National Health Service in England and Wales says it considers Enbrel (etanercept) and Humira (adalimumab) to be cost-effective as treatments for adults with active and progressive psoriatic arthritis, but only when the patient has peripheral arthritis with three or more tender joints and three or more swollen joints, and the disease has failed to respond to therapy with at least two standard disease-modifying anti-rheumatic drugs (DMARDs).

The annual cost of both Enbrel and Humira is around £9,295, while Remicade (infliximab) carries a slightly higher price tag of around £10,910, and the Institute has stressed that NHS doctors should only turn to Schering-Plough’s drug when patients are intolerant of, or have contraindications to, Enbrel and Humira.

In addition, the guidance stipulates that therapy with all three drugs should be stopped if an adequate response has not been achieved by 12 weeks, to avoid unnecessary expense to the health service.

Psoriatic arthritis is a progressive, inflammatory disease that affects the joints and connective tissue and can significantly affect patients’ quality of life. It is estimated that patients have a 60% higher risk of mortality than the general population, and life expectancy is around three years shorter.

“In updating our existing guidance on treating psoriatic arthritis, we have included adalimumab as an option alongside etanercept, in specific circumstances,” noted NICE’s Carole Longson, and she said the Institute hopes that the draft recommendations “will help in the management of this disabling disease.”

The closing dates for any comments on NICE’s proposed guidance is April 8, in time for a second appraisal meeting scheduled for April 20.