Title: Risankizumab for previously treated active psoriatic arthritis [ID1399]
Funder: Department of Health and Social Care

Abstract: Psoriatic arthritis (also called psoriatic arthropathy) is an inflammatory arthritis closely associated with psoriasis. It is estimated that around 1 in 5 people with psoriasis develop psoriatic arthritis.[1] In around 70% of people psoriasis precedes psoriatic arthritis.[2] The prevalence of psoriatic arthritis in England in 2020 was estimated to be around 84,500 adults.[2],[3] Men and women are equally likely to develop psoriatic arthritis with peak onset being between the ages of 30 and 50.[2]_x000D_ _x000D_ Although psoriatic arthritis is a chronic condition that progresses in the joints, its course may be erratic, with flare-ups and remissions. Arthritis symptoms can range from inflammation of the synovial membrane surrounding a joint (synovitis), ligaments and tendons (enthesitis and tendonitis), and inflammation of digits (dactylitis) to severe progressive erosion of the joints. Axial inflammation might also occur in some cases. Skin symptoms include the presence of patchy, raised, red areas of skin inflammation with scaling. This can affect any part of the body but is most commonly found on the extensor surfaces of the elbows and knees, the scalp and ears, the navel, and around the genital areas or anus. Nail symptoms include swelling, discolouration and pitting._x000D_ _x000D_ The aim of treatment is to suppress joint, tendon and ligament inflammation, and to manage the skin symptoms of the disease. Current practice involves early diagnosis and early use of non-biological disease-modifying anti-rheumatic drugs (DMARDs), including methotrexate, sulfasalazine and leflunomide, in order to minimise damage to joints. Non-steroidal anti-inflammatory drugs (NSAIDs), physiotherapy and intra-articular corticosteroid injections may also be used._x000D_ _x000D_ In addition, biological tumour necrosis factor (TNF)-alpha inhibitors and other non-conventional DMARDs (such as Janus kinase inhibitors and IL-17 inhibitors) may be used for treating people with active psoriatic arthritis. NICE recommends adalimumab, etanercept, infliximab, golimumab, certolizumab pegol, secukinumab, apremilast, ixekizumab or tofacitinib when a person has peripheral arthritis with 3 or more tender joints and 3 or more swollen joints, and the psoriatic arthritis has not responded to at least 2 standard DMARDs, given on their own or together (NICE technology appraisal guidance 199, 220, 445, 433, 537, and 543). Certolizumab pegol is also recommended when the disease has stopped responding to a TNF-alpha inhibitor after the first 12 weeks (NICE technology appraisal guidance 445). Ixekizumab, secukinumab and tofacitinib are also recommended in people whose disease has not responded within 12 weeks or stopped responding after 12 weeks of treatment with a TNF-alpha inhibitor or when TNF-alpha inhibitors are contraindicated but would otherwise be considered (NICE technology appraisal guidance 537, 445 and 543). Ustekinumab is recommended when treatment with TNF-alpha inhibitors is contraindicated but would otherwise be considered or the person has had treatment with 1 or more TNF-alpha inhibitors (NICE technology appraisal guidance 340). Guselkumab is recommended when a person has peripheral arthritis with 3 or more tender joints and 3 or more swollen joints, moderate to severe psoriasis and their disease has not responded well enough to, or they cannot tolerate, 2 conventional DMARDs and at least 1 biological DMARD (NICE Technology appraisal guidance 711). Biosimilar products for some of the biological therapies are also available for use in the NHS. _x000D_ _x000D_ References_x000D_ 1. Psoriasis Association (2018) Psoriasis Arthritis. Accessed July 2020_x000D_ 2. Ogdie, A., Langan, S., Love, T., Haynes, K., Shin, S., Seminara, N., Mehta, N., Troxel, A., Choi, H., Gelfand, J. (2013) ‘Prevalence and treatment patterns of psoriatic arthritis in the UK’. Rheumatology (Oxford) Mar 52(3): 568-75_x000D_ 3. Office for National Statistics (2021) Population estimates mid-year 2020. Accessed November 2021

Lay abstract: To appraise the clinical and cost effectiveness of risankizumab within its marketing authorisation for treating active psoriatic arthritis.

Research activity codes: 6.1 PHARMACEUTICALS
Health categories: INFLAMMATORY AND IMMUNE SYSTEM