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Ailesbury Clinic Blog

Psoriasis: Ixekizumab

The National Institute for Health and Care Excellence (NICE), in its final draft guidance issued this week, has recommended ixekizumab, an antibody that inhibits interleukin-17A, as an option for treating adults with severe plaque psoriasis that doesn’t respond to standard therapies.

The guidance recommended ixekizumab as an option for treating plaque psoriasis in adults, but only if they had severe disease (a total psoriasis area and severity index (PASI) score of 10 or more), which had not responded to standard systemic therapies such as ciclosporin or methotrexate or for patients in whom these were contraindicated or not tolerated.1

Ixekizumab is given by subcutaneous injection at a dose of 80 mg every two weeks for 12 weeks and then every four weeks. The list price is £1125 (€1300; $1370) for the 80 mg dose, but NICE has recommended that it be used only at the discounted cost agreed in a patient access scheme with the manufacturer.

The NICE draft appraisal recommended that ixekizumab be stopped after 12 weeks if a patient’s psoriasis had not responded adequately. Adequate response was defined as a 75% reduction in PASI score from when treatment started or a 50% reduction in PASI score together with a five point reduction in the dermatology life quality index.

After reviewing the available evidence the NICE appraisal committee concluded that ixekizumab was more clinically effective than placebo or etanercept (a tumour necrosis factor inhibitor) and had similar side effects to other biological treatments. The committee found that the incremental cost effectiveness ratio was within the range considered to be a cost effective use of NHS resources.

The draft guidance is out for consultation, and NHS organisations can make decisions on its use locally until it is finalised. If NICE confirms the draft recommendations the NHS must make sure it is available within three months of the final guidance being published.

 

1. NICE. Final appraisal determination. Ixekizumab for treating moderate to severe plaque psoriasis. March 2017. https://www.nice.org.uk/guidance/GID-TA10063/documents/final-appraisal-determination-document.

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