Details of HTA project
Last updated: 31 August 2010 - Next update due: 7 September 2010
Research type: |
NICE Technology Assessment Report (TAR) |
Project title: |
The clinical and cost effectiveness of etanercept, infliximab and adalimumab - psoriatic arthritis (guidance review 104 and 125) |
Link to NICE guidance page |
|
Project ref: |
08/42/01 |
Cost: |
This project has been commissioned by the HTA programme on behalf of the National Institute for Health and Clinical Excellence on a call-off contract basis. |
Chief Investigator : |
Centre for Reviews and Dissemination (CRD), University of York |
Start Date: |
June 2009 |
Estimated date of publication in HTA journal series: |
November 2010. This project is at the editorial review stage. Delays in the review process can cause the forecast publication date to be delayed. |
Plain English Summary |
Psoriatic arthritis is an inflammatory disease resulting in abnormality of joints. It is closely associated with psoriasis, which is a noncontagious inflammatory skin disease characterised by recurring reddish patches covered with silvery scales. Psoriatic arthritis is diagnosed when a patient has both psoriasis and typical inflammatory arthritis of the spine and/or other joints. It has been estimated that psoriatic arthritis occurs in 5-7% of those with psoriasis. Patients with psoriatic arthritis often have progressive joint deformity (ranging from mild inflammation of the layer of connective tissue that lines the cavities of joints to severe erosion of joints), as well as skin symptoms. Some patients have changes in the nails and small bones of the fingers or toes. All these symptoms can significantly impair a patient's health-related quality of life and social and psychological well-being. The treatment for psoriatic arthritis is to improve arthritis, psoriasis or both. Managing severe active psoriatic arthritis is often difficult. Currently, tumour necrosis factor alpha (TNF-?) inhibitors are used for the treatment of patients with severe active psoriatic arthritis. TNF-? is involved in the damaging process that affects cartilage and joints. Etanercept, infliximab and adalimumab are the licensed medicines to inhibit the activity of TNF-?. The purpose of this project is to assess the benefits and adverse effects of three TNF-? inhibitor treatments (etanercept, infliximab and adalimumab) for active and progressive psoriatic arthritis in patients who have an inadequate response to standard treatment. A further objective of this project is to evaluate whether these TNF-? inhibitor agents are cost-effective in these patients. |
Project Abstract: |
Numerous chemokines and cytokines are believed to play an important role in triggering cell proliferation and sustaining joint inflammation in psoriatic arthritis. Cytokines stimulate inflammatory processes that result in the migration and activation of T cells which then release tumour necrosis factor (TNF). TNF is one of several pro-inflammatory cytokines that have been implicated in the pathogenesis of both psoriasis and psoriatic arthritis. Newer strategies for the treatment of psoriatic arthritis have focused on modifying T cells in this disease through direct elimination of activated T cells, inhibition of T cell activation, or inhibition of cytokine secretion or activity. Etanercept, infliximab and adalimumab are among a number of these new biological agents that have been developed and investigated for the treatment of various diseases including psoriasis and psoriatic arthritis. Etanercept is a human dimeric fusion protein that binds specifically to TNF and blocks its interaction with cell surface receptors. Infliximab is a murine/human chimeric anti-TNF monoclonal gamma immunoglobulin that inhibits the binding of TNF to its receptor. Adalimumab is a fully humanised monoclonal IgG1 antibody and TNF antagonist. All three agents are licensed in the UK for the treatment of active and progressive PsA in adults when the response to previous DMARD therapy has been inadequate. The HTA Programme commissioned this technology assessmnet report on behalf of the National Institute for Health and Clinical Excellence. |
Project Protocol: |
Project protocol not available |
URL of this page: |
http://www.hta.ac.uk/2053 |
News feeds