Etanercept and infliximab for the treatment of psoriatic arthritis
BackgroundPsoriatic arthritis is a hyperproliferative and inflammatory arthritis that is distinct from rheumatoid arthritis (RA) and closely associated with psoriasis. In the UK both etanercept and infliximab are recently licensed drugs for the treatment of adults with active and progressive psoriatic arthritis. We undertook a systematic review of the efficacy and safety of etanercept and infliximab and an update of an existing systematic review of other treatments for psoriatic arthritis. In addition a systematic review and critique of existing economic evaluations of etanercept or infliximab was conducted, which informed the development of an economic model of etanercept and infliximab.
The limited data available indicate that etanercept and infliximab are efficacious in the treatment of psoriatic arthritis with beneficial effects on both joint and psoriasis symptoms and on functional status. Short-term data indicate that both drugs can delay joint disease progression. Further long-term data are required to confirm and consolidate the evidence base. The available drug treatments for psoriatic arthritis, with the exception of sulphasalazine and possibly leflunomide, have not been investigated thoroughly. The available limited data indicated some degree of efficacy for all DMARDs but the evidence for IM gold and azathroprine was particularly weak and may not be reliable. The economic model indicated that etanercept is more cost-effective than infliximab as it has a lower cost with little difference in outcomes.Conducted by: N Woolacott1, Y Bravo Vergel2, N Hawkins2, A Kainth1, Z Khadjesari1, K Misso1, K Light1, C Asseburg2, S Palmer2, K Claxton2, I Bruce3, M Sculpher2, R Riemsma1
1. Centre for Reviews and Dissemination; 2. Centre for Health Economics, University of York; 3. ARC Epidemiology Unit, University of Manchester
Further detailsProject page on HTA Programme website
Related guidanceCommissioned to inform NICE Technology Appraisal 104: Etanercept and infliximab for the treatment of adults with psoriatic arthritis. London: National Institute for Health and Clinical Excellence; 2006
Woolacott N, Bravo Vergel Y, Hawkins H, Kainth A, Khadjesari Z, Misso K, Light K, Asseburg C, Palmer S, Claxton K, Bruce I, Sculpher M, Riemsma R. Etanercept and infliximab for the treatment of psoriatic arthritis; a systematic review and economic evaluation. Health Technol Assess. 2006;10(31):1-258
Bravo Vergel Y, Hawkins NS, Claxton K, Asseburg C, Palmer S, Woolacott N, Bruce IN, Sculpher MJ. The cost-effectiveness of etanercept and infliximab for the treatment of patients with psoriatic arthritis. Rheumatology. 2007;46(11):1729-35Woolacott NF, Khadjesari ZC, Bruce IN, Riemsma RP. Etanercept and infliximab for the treatment of psoriatic arthritis: a systematic review. Clin Exp Rheumatol. 2006;24(5):587-93