The U.K.’s National Institute for Health and Care Excellence (NICE) has approved the use of Cimzia (certolizumab pegol) and Cosentyx (secukinumab), alone or in combination with Nordimet (methotrexate), for the treatment of active psoriatic arthritis (PsA) in England and Wales.

Psoriasis is an autoimmune disease cause by hyper activation of the immune system and uncontrolled inflammation in the skin. Many psoriasis patients also have stiffness, pain, and swelling in the joints due to increased inflammation, which is characteristic of PsA.

First-line therapy for these patients is based on the use of disease-modifying anti-rheumatic drugs (DMARDs) to avoid joint damage and disease progression. However, not all patients respond to these therapies. After unsuccessful DMARDs, patients may receive what is called biological therapies, which modulate the disease symptoms by specifically inhibiting molecules involved in the inflammatory process.

Cimzia, marketed by UCB Pharma, is a biologic medication that blocks a signaling molecule called TNF-alpha. This molecule is commonly found elevated in psoriasis patients and is associated with the activation of inflammatory process and hyper activation of the immune system, contributing to joint damage.

Cosentyx, marketed by Novartis, is also a biologic medication. It binds to a molecule called interleukin-17, which is necessary for a normal response from the immune system. Because of its impact on the immune system, this therapy can reduce inflammation and many symptoms of psoriasis.

Both Cosentyx and Cimzia have been approved by the FDA and the EMA for the treatment of active ankylosing spondylitis (AS) and PsA.

Based on results from a total of 17 clinical trials showing the benefits of both drugs on psoriatic arthritis, NICE has approved the use of Cimzia and Cosentyx for treatment of PsA in adults who did not respond to previous DMARD or anti-TNF therapies, both as monotherapy or in combination with Nordimet.

The use of both drugs should follow the NICE psoriatic arthritis treatment guidance, also applicable for other treatments such as Enbrel (etanercept), Remicade (infliximab), and Humira (adalimumab).

Like many other biologic treatments for psoriasis and psoriatic arthritis, Cosentyx and Cimzia are administered via injection. Because of their impact on the immune system a close follow-up should be performed to avoid infections or more serious treatment-related side effects.

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