The National Institute for Health and Care Excellence (NICE) has recommended tildrakizumab (Ilumetri) and certolizumab pegol (Cimzia) as individual treatment options for moderate-to-severe plaque psoriasis.
Tildrakizumab and certolizumab pegol are recommended for the treatment of adults with plaque psoriasis if the following conditions are fulfilled:
- 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 phototherapy.
The recommended dose for tildrakizumab is 100 mg subcutaneously at weeks 0 and 4 and every 12 weeks thereafter. A 200-mg dose may be appropriate for individuals with high disease burden or body weight ≥90 kg. Continuation of therapy should be reconsidered if psoriasis has not responded adequately after 28 weeks.
The recommended loading dosage for certolizumab pegol is 400 mg subcutaneously at weeks 0, 2 and 4, followed by a maintenance dose of 200 mg (lowest licensed maintenance dose) every 2 weeks. A maintenance dose of 400 mg every 2 weeks may be considered in case of inadequate response. Continuation of therapy should be reconsidered after 16 weeks if psoriasis has not responded adequately.
The drugs are to be used only when provided by the company in agreement with the commercial arrangement. The recommendations should not affect patients whose treatment with the drugs was started before publication of the guidance.