The National Institute for Health and Clinical Excellence has widened the proposed criteria for treating psoriatic arthritis with Schering-Plough’s Remicade on the National Health Service, improving access to therapies for the disease.

In final draft guidance the Institute not only endorsed the use of Pfizer’s Enbrel (etanercept) and Abbott’s Humira (adalimumab) as options for treating adults with active and progressive psoriatic arthritis but has also added Remicade (infliximab) to the mix, marking a change of heart from its previous recommendations in which the latter was only to be used if Enbrel or Humira can’t be used.

Following a cost analysis and subsequent public consultation NICE has ruled that all of these three drugs offer the NHS value for money, but it stipulates that they are only to be given if 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 “adequate trials” of at least two standard disease-modifying anti-rheumatic drugs (DMARDs).

Treatment with Enbrel or Humira costs around £9,295 a year, while Remicade carries a slightly higher price tag of around £10,910, and the Institute has emphasised that therapy should be started with the cheapest medicine, particularly as the expense can vary depending on factors such as drug administration costs and required dose, but that the administration requirements of each patient should also be taken into account.

Dr Volker Koscielny, Inflammatory Medical Team Lead at Pfizer, has welcomed NICE’s guidance for treatment patients with psoriatic arthritis, and says it will “provide clinicians with the choice to prescribe the appropriate treatment based on individual patient need”.