PSORIASIS

Etanercept and efalizumab for the treatment of psoriasis: a systematic review

Background

Psoriasis is a chronic skin disorder that can be physically and emotionally debilitating and which can require life-long treatment. In the UK both etanercept and efalizumab have recently been licensed for the treatment of adults with moderate to severe plaque psoriasis. Both etanercept and efalizumab are new biologic agents, which target pathologic T cell activity. Other therapies available for the treatment of moderate to severe psoriasis include photo-chemotherapy and systemic agents such as ciclosporin, methotrexate and retinoids, all of which have limitations on their use due to serious long-term adverse effects.

We undertook a systematic review of the efficacy and safety of etanercept and efalizumab and an update of an existing systematic review of other treatments; and a mixed treatment comparison analysis to enable comparisons to be made between the efficacy of all treatments. Following a systematic review and critique of existing economic evaluations of etanercept or efalizumab an economic model of etanercept and efalizumab was developed.

Findings

Overall, clinical trial data indicate that both etanercept and efalizumab are efficacious in patients who are eligible for systemic therapy. Despite widespread use and numerous trials, it was difficult to draw firm conclusions regarding the efficacy of the other treatments available for the relief of moderate to severe chronic plaque psoriasis. In a mixed treatment comparison, including etanercept, efalizumab, ciclosporin, Fumaderm, methotrexate, infliximab and placebo, infliximab appeared the most effective followed by methotrexate and ciclosporin. The economic evaluation demonstrates that etanercept and efalizumab are likely to be cost-effective only in patients with poor baseline quality of life and who are at risk of hospitalisation for the treatment of their psoriasis.

Conducted by: N Woolacott¹

, N Hawkins², A Mason², A Kainth¹, Z Khadjesari¹, Y Bravo Vergel², K Misso¹, K Light¹, R Chalmers³, M Sculpher², R Riemsma¹

1. Centre for Reviews and Dissemination; 2. Centre for Health Economics, University of York; 3. Dermatology Centre, University of Manchester

Further details

Project page on HTA Programme website

Related guidance

Commissioned to inform NICE Technology Appraisal 103: Etanercept and efalizumab for the treatment of adults with psoriasis. London: National Institute for Health and Clinical Excellence; 2006

Publications

Woolacott N, Hawkins N, Mason A, Kainth A, Khadjesari Z, Bravo Vergel Y, Misso K, Light K, Chalmers R, Sculpher M, Riemsma R. Etanercept and efalizumab for the treatment of psoriasis: a systematic review. Health Technol Assess. 2006;10(46):1-252

Presentations

Woolacott N, Kainth A, Hawkins N, Khadjesari Z, Light K, Riemsma R. Efalizumab and etanercept for the treatment of psoriasis: a systematic review. Health Technology Assessment International (HTAi) Annual Meeting; 2005 June; Rome, Italy

Funding

Commissioned by the HTA Programme on behalf of NICE's Technology Assessment Report (TAR) process

Status: Completed