- with at least 3 tender and 3 swollen joints who have responded inadequately to treatment with at least 2 DMARDs, given either alone or in combination, or
- who have had an inadequate response (in the case of secukinumab) or lost response to a tumour necrosis factor (TNF) inhibitor after 12 weeks of treatment, or
- in whom TNF inhibitors are contraindicated but would otherwise be considered (this applies to secukinumab only).
Certolizumab pegol blocks the activity of TNF, a major contributor to inflammation and joint damage, whereas secukinumab neutralises interleukin-17A (IL-17A), which could benefit patients intolerant to TNF inhibitors.
Treatment with certolizumab pegol and secukinumab should only be continued if there is an adequate response according to the Psoriatic Arthritis Response Criteria (PsARC; defined as an improvement in at least 2 of the 4 criteria, including joint tenderness or swelling, with no worsening in any criteria), at 12 weeks and 16 weeks respectively. For patients who achieve a Psoriasis Area and Severity Index (PASI) 75 response but not a PsARC response, a dermatologist should decide whether continuing treatment is appropriate.
In both cases the company must provide the drug within the discount agreed in the patient access scheme. Treatment of patients already receiving either drug may continue according to whatever funding arrangements were in place before the guidance was issued until the patient and their NHS clinician consider it appropriate to stop.