National Institute for Health and Care Excellence (NICE) has recommended brodalumab (Kyntheum) as a treatment option for moderate to severe plaque psoriasis.
Brodalumab is recommended for the treatment of adults with plaque psoriasis if the following conditions are fulfilled:
- Severe disease: Psoriasis Area and Severity Index (PASI) of ≥10 and Dermatology Life Quality Index (DLQI) of >10.
- Inadequate response, intolerance or contraindication to other systemic therapies, including ciclosporin, methotrexate, and psoralen + long-wave ultraviolet A radiation.
The recommended dose for brodalumab is 210 mg given subcutaneously at weeks 0, 1 and 2, and subsequently 210 mg every 2 weeks. Therapy should be discontinued if psoriasis has not responded adequately after 12 weeks. An adequate response is defined as a 75% reduction in PASI or a 50% reduction in PASI + 5-point reduction in DLQI.
Evidence has shown better improvement of severe psoriasis with brodalumab compared with placebo and ustekinumab. Brodalumab has comparable efficacy to anti-IL-17 agents in indirect comparison. It also appears to generally more cost-effective compared with other biologicals as well as apremilast and dimethyl fumarate.
The drug is to be used only when it is discounted by the company in agreement with the patient access scheme. The recommendations should not affect patients whose treatment with the drug was started before publication of the guidance.
