Patients with plaque psoriasis could be getting access to Celgene's Otezla on the National Health Service in England and Wales after all, following a u-turn by cost regulators.

The National Institute for Health and Care Excellence has now published draft guidance recommending the drug's use in certain scenarios, after initially rejecting its use in September last year.

The new draft guidelines approve NHS funding for Otezla (apremilast) when used to treat the condition in patients whose disease has not responded to other systemic therapies, such as ciclosporin or methotrexate, or these treatments are contraindicated or the person cannot tolerate them.

However, NICE has stipulated that the disease must be classed as severe - as defined by a total Psoriasis Area Severity Index (PASI) of 10 or more and a Dermatology Life Quality Index (DLQI) of more than 10 - and that the recommendation is continent on Celgene providing the drug with the discount agreed in the patient access scheme.

Otezla's NHS list price is £265.18 for a 14-day treatment initiation pack (4×10mg, 4×20mg and 19×30mg) and £550.00 for a 28-day pack (56×30mg).

The drug 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.