Title: Brodalumab for treating moderate to severe plaque psoriasis [ID878]
Funder: Department of Health and Social Care

Abstract: To appraise the clinical and cost effectiveness of brodalumab within its marketing authorisation for treating moderate to severe plaque psoriasis.

Lay abstract: Psoriasis is an inflammatory skin disease that is characterised by an increased turnover of the upper layer of the skin (epidermis). Although it is a chronic condition, its course may be unpredictable, with flare-ups and remissions. Psoriasis can be psychologically distressing to people. The most common form of psoriasis is chronic plaque psoriasis (psoriasis vulgaris), which is characterised by well-demarcated, often symmetrically distributed thickened, red, scaly plaques. Although the plaques can affect any part of the skin, they are typically found on the extensor surfaces of the knees and elbows, and on the scalp. Psoriasis can be graded as mild, moderate or severe according to the body surface area affected or by using indices such as the Psoriasis Area Severity Index (PASI), which takes into account the size of the area covered with psoriasis as well as redness, thickness and scaling. In addition, the Dermatology Life Quality Index (DLQI) is a validated tool that can be used to assess the impact of psoriasis on physical, psychological and social wellbeing. The prevalence of psoriasis in England is estimated to be 1.75%1, which is about 959,000 people, of whom about 20% have moderate to severe psoriasis (15% moderate, 5% severe)2, equating to approximately 190,000 people. Approximately 90% of people with the condition have plaque psoriasis. There is no cure for psoriasis but there are a wide range of topical and systemic treatments that can manage the condition. Most treatments reduce severity rather than prevent episodes. Psoriasis has to be treated continually and on a long-term basis. NICE clinical guideline 153 (2012) describes the care pathway for people with psoriasis. Initially, psoriasis is managed with topical treatments, including emollients and occlusive dressings, keratolytics (salicylic acid), coal tar, dithranol, corticosteroids and vitamin D analogues. Phototherapy may be used for people with plaque psoriasis that cannot be controlled with topical treatments. Systemic non-biological therapies (such as methotrexate, ciclosporin and acitretin) should be offered to people with any type of psoriasis if: it cannot be controlled with topical therapy and • it has a significant impact on physical, psychological or social wellbeing and • one or more of the following apply: o psoriasis is extensive or o psoriasis is localised and associated with significant functional impairment and/or high levels of distress or o phototherapy has been ineffective, cannot be used or has resulted in rapid relapse. NICE technology appraisals 103, 134, 146, 180, 350 and 442 recommend biological therapies for people with psoriasis for whom other systemic therapies including ciclosporin, methotrexate and phototherapy with or without psoralen have been inadequately effective, not tolerated or contraindicated. Etanercept (technology appraisal [TA] 103), adalimumab (TA146), ustekinumab (TA180), secukinumab (TA350), apremilast (TA419) and ixekizumab (TA442) are recommended as treatment options for people with severe psoriasis (as defined by a total PASI score of 10 or more and a DLQI score of more than 10). Infliximab (TA134) is recommended as an option for people with very severe psoriasis (PASI score of 20 or more and a DLQI score of more than 18).

Research activity codes: 6.1 PHARMACEUTICALS
Health categories: SKIN