Use standard systemic therapies for

NICE guidance on biologic drugs for the

psoriasis including ciclosporin,
treatment of psoriasis (January 2011)
methotrexate and PUVA
Yes This algorithm is a tool to aid the implementation of
No – consider NICE guidance on biologic drugs for the treatment of
alternative Is the patient’s condition responding to
psoriasis. It includes all of the biologic drugs approved
standard standard systemic therapies?
by NICE for treatment of this condition at the time of
treatment No publication in January 2011.
options
Is the patient intolerant to, or do they Commissioners and clinicians should refer to the
have a contraindication to, these relevant technology appraisal for each biologic drug for
treatments? further information about their eligibility and
prescription.
Yes

What are the patient’s PASI Key to terms:

and DLQI scores? PASI: psoriasis area severity index
DLQI: dermatology life quality index
PUVA: psoralen and long-wave ultraviolet radiation
Patient is not TA: NICE technology appraisal
PASI < 10 PASI ≥ 10 PASI ≥ 20
eligible for
and and and
treatment with
DLQI of ≤ 10 DLQI of > 10 DLQI > 18
biologic drugs

Use one of the following treatment

Use one of the following treatment
options:
options:
Adalimumab (TA146) or
Adalimumab (TA146) or
Etanercept (TA103) or
Etanercept (TA103) or
Infliximab (TA134) or
Ustekinumab (TA180)
Ustekinumab (TA180)

Is there an adequate response to

Yes – maintain Is there an adequate response to Yes – maintain
treatment defined as:
same treatment treatment defined as: same treatment
and monitor patient 75% reduction in PASI score from when and monitor patient
75% reduction in PASI score from when
treatment started (PASI 75) or
treatment started (PASI 75) or
50% reduction in PASI score (PASI 50)
50% reduction in PASI score (PASI 50)
and 5-point reduction in DLQI from when
and 5-point reduction in DLQI from when
treatment started
treatment started
To be measured at:
To be measured at:
10 weeks for infliximab
12 weeks for etanercept
12 weeks for etanercept
16 weeks for adalimumab and
16 weeks for adalimumab and
ustekinumab
ustekinumab
No No

Discontinue treatment with the drug used