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Latest Psoriasis Association News

NICE technology appraisal guidance 199 – Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis

On 25th August 2010, NICE replaced its existing guidance regarding psoriatic arthritis – etanercept and infliximab, and psoriatic arthritis – adalimumab. NICE regularly reviews each piece of guidance it issues. The review of these treatments for psoriatic arthritis has resulted in an extension to the guidance:

Etanercept, infliximab and adalimumab are all recommended for the treatment of active and progressive psoriatic arthritis, based on specific criteria. Treatment choice should be started with the least expensive drug (taking into account drug administration costs, required dose and product price per dose).

The guidance recommends that treatment should be discontinued if people’s disease does not show an adequate response on the Psoriatic Arthritis Response Criteria (PsARC) at 12 weeks. Healthcare professionals should also consider continuing treatment if people’s skin disease has a Psoriasis Area and Severity Index (PASI) 75 response at 12 weeks in the absence of adequate PsARC response. This assessment should be done by a dermatologist to determine whether continued treatment is appropriate on the basis of the skin response alone.

Etanercept, infliximab and adalimumab are recommended for the treatment of adults with active and progressive psoriatic arthritis when the following criteria are met:
*The person has peripheral arthritis with three or more tender joints and three or more swollen joints, and
* The psoriatic arthritis has not responded to adequate trials of at least two standard disease-modifying antirheumatic drugs (DMARDs), administered either individually or in combination.

Whilst NICE recommends that treatment should begin with the least expensive drug, this can differ depending on agreements between your local health authority and the pharmaceutical company. Cost variations differ also as the drugs each have different doses, for example, adalimumab is a set dose irrespective of weight, whereas infliximab is a weight dependent dose. The NICE committee considered that there was insufficient evidence of superiority of any one agent over the others.

The Secretary of State and the Welsh Assembly Minister for Health and Social Services have issued directions to the NHS on implementing NICE technology appraisal guidance. When a NICE technology appraisal recommends use of a drug or treatment, or other technology, the NHS must provide funding and resources for it within 3 months of the guidance being published. If the Department of Health issues a variation to the direction, details will be available on the NICE website. The NHS is not required to fund treatments that are not recommended by NICE.

For further info, please visit: http://guidance.nice.org.uk/TA199

Response to research covered by the BBC: Women beer drinkers "increase risk of psoriasis"

This large study of female nurses has highlighted some interesting findings regarding women and psoriasis. This most recent study has identified a link between women drinking beer and the onset of psoriasis, however, further research is required in order to find out the reason for this. Whilst anecdotally some people with psoriasis have found benefit from dietary changes, this has not been replicated in larger clinical trials. The Psoriasis Association therefore advises anyone thinking of changing their diet to first speak to a dietitian or GP in order to ensure they are eating a healthy, varied diet.

Alcohol intake should be sensible and moderate following government guidelines for the rest of the population, or following advise from a dermatologist should you be on medication such as methotrexate or acitretin.


 

NEW BBC ONE SHOW RECRUITING VOLUNTEERS
The BBC are currently recruiting volunteers for their new health show and ask -

Are you suffering from a skin condition that isn’t responding to treatment?
Are you unsure what this skin condition is?
Is your condition affecting the way you look, your confidence and your emotional wellbeing?
Do you want to know what’s wrong with you and get treatment?
Maverick Television, makers of Embarrassing Bodies are producing a brand-new health show for BBC One.
Please email us with a detailed description of your health problem, photos, plus your contact details.
Email: whatswrongwithme@mavericktv.co.uk Phone Number: 0207 874 6660


FUNDRAISING

Alan Bentley is walking Wainwright's Coast to Coast trail (all 192.5 miles of it!) to raise money for the Psoriasis Association. His challenge starts in early October, and of course we wish him the best of luck! Show your support and sponsor him at his JustGiving page.

Cara Lewis is participating in this year's Mayor of London's Skyride to raise money for the Psoriasis Association. It takes place on Sunday 5th September and sounds like it will be a lovely day! Please sponsor her at her JustGiving page.

If you would like to raise money for the Psoriasis Association, please get in touch!


PsAPods LAUNCH

The Psoriasis Association is delighted to announce the launch of 5 new podcasts regarding Psoriatic Arthritis. The podcasts take the form of interviews, with Dr Philip Helliwell, rheumatology nurse Charlie Davis, and patient Elizabeth Maw, to cover all aspects of the condition; symptoms, treatments, everyday living, medical appointments, and upcoming research in the area. These are essential resources for anyone; newly diagnosed, living with the condition, or simply wanting to find out more about Psoriatic Arthritis.
Click here to download the PsAPods FREE.

 

Do you live in Scotland and have Psoriasis or Psoriatic Arthritis?

The School of Pharmacy and Life Sciences at Robert Gordon University are carrying out research looking at patient perceptions of, and satisfaction with their Psoriasis. The research is being carried out using an online survey and takes between 10 and 15 minutes to complete:

www.rgu.ac.uk/psoriasis-study-Aberdeen



The 'Skin' Exhibition at the Wellcome 10th June - 26th September 2010
The 'Skin' exhibition invites you to re-evaluate the largest and probably most overlooked human organ. We will consider the changing importance of skin, from anatomical thought in the 16th century through to contemporary artistic exploration.
Covering four themes (Objects, Marks, Impressions and Afterlives), 'Skin' takes a philosophical approach. It begins by looking at the skin as a frontier between the inside and the outside of the body. Early anatomists saw it as having little value and sought to flay it to reveal the workings of the body beneath.
The exhibition then moves to look at the skin as a living document: with tattoos, scars, wrinkles or various pathologies, our skin tells a story of our life so far. Finally, the skin is considered as a sensory organ of touch and as a delicate threshold between life and death.
Included in the exhibition will be the psoriasis ceramic by Tamsin van Essen.
For further information on the Skin exhibition, please visit the Wellcome website www.wellcomecollection.org/whats-on/exhibitions/skin.aspx
The Wellcome is located at 183 Euston Road, London, NW1 2BE - with late opening on Thursdays until 10pm
.


Patients speaking podcasts
To complement the existing medical information podcasts, we are delighted to launch 6 new patient experiences podcasts. You can listen at
www.psoriasis-association.org.uk/podcasts.html


Visit us on Facebook! www.facebook.com/psoriasisassociation

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PsoKids CD-ROM
Lots of things can go wrong with the skin that we can't help happening and psoriasis is just one of them. An important thing is to remember that you're not alone. There are lots of people all over the world who have psoriasis and deal with it every single day! PsoKids is an interactive, fun packed CD-ROM designed mainly for children (although there is a bit on their for parents/carers too!). To order your free copy, please contact us

Treatment / Company / Product Information

NICE issue final appraisal determination for etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis (review of previous technology guidance)
In the final draft guidance (one step before full guidance) NICE has recommended the use of etanercept (enbrel), infliximab (remicade) and adalimumab (humira) for the treatment of adults with active and progressive psoriatic arthritis when the following criteria are met:
1. The person has peripheral arthritis with three or more tender joints and three or more swollen joints, and
2. The psoriatic arthritis has not responded to adequate trials of at least two standard disease-modifying antirheumatic drugs (DMARDs), administered individually or in combination.

Treatment should normally be started with the least expensive drug (taking into account administration costs, required dose and product price per dose). This may need to be varied for individual patients because of differences in the method of administration and treatment schedules.
Etanercept, adalimumab or infliximab should be discontinued in people whose psoriatic arthritis has not shown an adequate response at 12 weeks. For further information, please visit www.nice.org.uk


Pinetarsol Solution and Pinetarsol Bath Oil
We have received notification from Crawford Pharmaceuticals that due to a packing issue with the Pinetarsol Solution 200ml and 500ml and Pinetarsol Bath Oil 200ml and 500ml that has been unable to be resolved, these products are now no longer going to available in the UK marketplace. Crawford Pharmaceuticals said "i
t is an issue which came about unexpectedly and, although we have looked at various options to resolve the issue and bring the product back onto the market place, no solution was viable in the end." Crawford Pharmaceuticals advise that Pinetarsol is available direct from Australia via the two websites below and recommend these two websites to members of the public.
www.yourchemistshop.com.au
www.epharmacy.com.au

Dovonex Ointment
LEO Pharmaceuticals are now manufacturing Dovonex (Calcipotriol) Ointment again, to complement the existing Dovonex Cream and Dovonex Scalp solution products they currently have available on prescription only.


Betesil
Betamethasone Valerate has been a popular potent topical steroid for a number of years. You may recognise it better as the active ingredient in Betnovate, Bettamousse and Fucibet. It is now available (on prescription only) as a plaster application for people with very localised plaque psoriasis, in particular in difficult to treat areas with topical treatments such as the elbows, knees and feet, covering less than 5% of the body surface area. Each plaster measures 7.5cm x 10cm. To use Betesil, you clean and dry the area you are treating, then cut the plaster to fit over the plaque of psoriasis (any plaster left over can be put back into the protective sleeve and used at a later date). The clear plaster is left in place for 24 hours. After removal of the plaster the following day, allow 30 minutes before applying a fresh treatment.
Betesil is not intended for use for longer than a 30 day period.
Please do not simply cover your existing steroid applications with a plaster as this will increase the potency of the steroid and so the likelihood of potential side effects. Betesil has been formulated in order to give a regulated amount of Betamethasone Valerate under occlusion.



The Psoriasis Association is pleased to inform you that Stelara (Ustekinumab) has been approved by the National Institute for Health and Clinical Evidence (NICE) for funding by the NHS (subject to conditions). For further information please visit http://guidance.nice.org.uk/TA180

European Medicines Agency recommends suspension of the marketing authorisation of Raptiva (Efalizumab)
The European Medicines Agency (EMEA) has recently reviewed Efalizumab (Raptiva) following concerns regarding the long-term safety for patients. The EMEA have recommended that the marketing authorisation should be withdrawn across Europe. Patients currently using Raptiva should make an appointment with their Dermatologist to discuss an alternative treatment, but should not stop Rapitva abruptly.
Patients who have taken Raptiva in the past and have any questions or concerns should make an appointment with their GP or Dermatologist.
For further information, please visit
http://www.emea.europa.eu/humandocs/PDFs/EPAR/raptiva/RaptivaQ&A_1552509en.pdf

Xamiol Gel
Leo Pharma has recently launched a new product to treat scalp psoriasis – Xamiol (pronounced zamiol) gel. It contains the same active ingredients as Dovobet (calcipotriol – the vitamin D component and betamethasone – the steroid component).
To use Xamiol, part your hair into sections, and then apply the gel with your fingers to the areas of psoriasis on your scalp. Rub the gel in with your fingertips. For best results Leo Pharma recommend you leave the gel on overnight, and then wash it out the next morning. In order to wash Xamiol gel out of the hair, apply a mild shampoo to dry hair, especially to the areas that the gel was applied, leave the shampoo on for a couple of minutes and then wash your hair as usual. You may need to wash your hair twice.
Xamiol gel is available on prescription only.


NICE issue Guidelines regarding the use of Adalimumab (Humira) for severe psoriasis
The National Institute for Health and Clinical Excellence (NICE) have issued their guidelines regarding the use of
Adalimumab to treat psoriasis. NICE have recommended Adalimumab be prescribed when "the condition is severe" - defined by a PASI score greater than 10 and a DLQI score greater than 10, and "their condition has not improved with other treatments such as ciclosporin, methotrexate and PUVA (psoralen and long-wave ultraviolet radiation), or they have had side effects with these in the past or there is a medical reason why they should not be given these treatments."
To read the guidelines, please follow the link to the NICE website. For further information on Adalimumab, please click here

NICE issue Guidelines regarding the use of Infliximab (Remicade) for severe psoriasis
The National Institute for Health and Clinical Excellence (NICE) have issued their guidelines regarding the use of Infliximab to treat psoriasis. NICE have recommended Infliximab be prescribed when "the disease is very severe as defined by a total Psoriasis Area Severity Index (PASI) of 20 or more and a Dermatology Life Quality Index (DLQI) of more than 18
" and "the psoriasis has failed to respond to standard systemic therapies such as ciclosporin, methotrexate or PUVA, or the person is intolerant to or has a contraindication to these treatments". To read the guidelines, please follow the link to the NICE website. For further information on Infliximab, please click here

Adalimumab (Humira) receives its license for use to treat moderate to severe psoriasis
Adalimumab is the first fully human anti-TNF (tumour necrosis factor) monoclonal antibody approved for the treatment of plaque psoriasis. “The licensing of adalimumab offers a valuable new treatment option for people living with moderate-to-severe psoriasis, a very difficult and often isolating condition,” said Gladys Edwards from the Psoriasis Association. ”We welcome the approval of new therapies such as adalimumab that can significantly improve the quality of life of patients and expand the options available to those who are most in need of treatment.”
Adalimumab is a subcutaneous injection, meaning it can be self-administered at home after suitable training. For further information regarding Adalimumab please click here


Etrivex Shampoo
Galderma (UK) has recently launched a new product for the treatment of moderate scalp psoriasis in adults. Etrivex is a short contact corticosteroid shampoo that is only available on prescription. It is stocked by all wholesalers and most pharmacies. It is important to follow the instructions carefully as the method of application is different to that of conventional treatments - approximately half a tablespoon (7.5ml) should be applied directly to your dry scalp and massaged into the lesions. Etrivex should be left in place for 15 minutes. Then, add water and lather, avoiding contact with the eyes and other delicate areas - rinse thoroughly, condition and style as normal.

Availability of Psorin Ointment and Scalp Gel
LPC Pharmaceuticals have informed the Psoriasis Association that Psorin Scalp Gel is available, but Psorin Ointment is being reviewed by the MHRA - no indication has been given as to when this will become available again.



Patient Information Leaflets (PIL's)
Do you discard the packaging your medications come in only to find a couple of weeks later that you could do with knowing a little more about your treatment? Well help is at hand! ALL PIL's can now be accessed online at http://emc.medicines.org.uk/



Psoriasis Support Groups

London Group Dermatology Department, Whittington Hospital, Highgate Hill
Thursday Sept 2nd- 2pm-4pm
Thursday Dec 16th- 2pm-4pm
Reading Group Wednesday 27th January, 7-9pm at the Royal Berkshire Hospital. Park in the Redlands road carpark and go to Outpatients 2 (parking permits will be provided on the night)
Salford Support Group Second Wednesday of every month in Community Room 2, Pendleton Gateway Centre, Lime Court, Salford, at 2pm
Salisbury Psoriasis Support Group Take place in the Railway Tavern, Mill Road, Salisbury and commence at 7.00pm
Wednesday 12th May 2010 - talk from a nutritionist
Wednesday 14th July 2010 - BBQ
Treliske (Cornwall) Support Group

Meet in the Dermatology Unit, Treliske Hospital at 6.30 - 8.00pm
Wednesday 4th August 2010
Wednesday 3rd November 2010

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