Cimzia & Cosentyx - New Biologic Treatments Approved for Psoriatic Arthritis

Cimzia (Certolizumab Pegol) and Cosentyx (Secukinumab) get the go-ahead from NICE.

The National Institute for Health and Care Excellence (NICE) has today published its decision to recommend the biologic medicine Cimzia (also known by its generic name, Certolizumab Pegol) as a treatment option for adults with psoriatic arthritis in England and Wales.

Cimzia, either alone or with methotrexate, may be prescribed only if:

• 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 at least two standard disease-modifying antirheumatic drugs (DMARDs), given either alone or in combination.
• The person has had a biologic treatment from the tumour necrosis factor (TNF)-alpha inhibitor class (such as Adalimumab, Etanercept, Infliximab or Simponi) but their psoriatic arthritis has stopped responding after the first 12 weeks.

As part of the same technology appraisal, NICE also recommended another biologic medicine, Cosentyx (also known by its generic name, Secukinumab) as a treatment option for adults with psoriatic arthritis in England and Wales.

Cosentyx, either alone or with methotrexate, may be prescribed only if:

• 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 at least two standard disease-modifying antirheumatic drugs (DMARDs), given either alone or in combination.
• The person has had a biologic treatment from the tumour necrosis factor (TNF)-alpha inhibitor class (such as Adalimumab, Etanercept, Infliximab or Simponi) but their psoriatic arthritis has not responded within the first 12 weeks or has stopped responding after the first 12 weeks, or;
• Biologics from the tumour necrosis factor alpha (TNF)-alpha inhibitor class are contraindicated (should not be used in this case) but would otherwise be considered

NICE used a process known as a Multiple Technology Appraisal (MTA) to assess Cimzia and Cosentyx for psoriatic arthritis at the same time.

Cimzia (Certolizumab Pegol)

How does Cimzia work?

Cimzia blocks tumour necrosis factor-alpha (TNF alpha) a chemical ‘messenger’ in the immune system that signals other cells to cause inflammation. There is too much TNF alpha in the skin of people with psoriasis and the joints of people with psoriatic arthritis, which causes inflammation and can lead to tissue and joint damage. TNF alpha can also lead to increased activity of the immune system by switching on certain white blood cells in the body, called T Cells. Once T cells become overactive they can trigger inflammation and other immune responses, encouraging the development of psoriasis and/or psoriatic arthritis.

Cimzia helps lower the amount of TNF alpha to more normal levels, and switches off the inflammatory cycle of psoriasis and/or psoriatic arthritis. This leads to improvement in symptoms for many people who take it.

How is Cimzia used?

Individuals take Cimzia at home by giving themselves an injection under the skin via a pre-filled ‘pen’ device. Most people will be trained by a nurse to give the injection to themselves. After the ‘starting dose’ of two injections (400mg) at weeks 0, 2 and 4, patients take one injection (200mg) of Cimzia every two weeks. Cimzia can be prescribed by itself or is sometimes used in combination with methotrexate.

People taking Cimzia will have regular blood tests every three to six months - usually carried out by Dermatology or Rheumatology Nurses, or by their own GP - to monitor for infections or other possible effects of the treatment. People taking Cimzia should have an annual flu jab, but should check with a doctor or nurse before having any other vaccinations or taking other medication.

For more information on Cimzia, have a read of our information sheet.

Cosentyx (Secukinumab)

How does Cosentyx work?

Cosentyx binds to a cytokine (chemical messenger) called interleukin-17A (IL-17A), which is involved in the body’s inflammatory and immune responses. There are higher levels of IL-17A in psoriatic plaques than in non-psoriatic skin. By binding to IL-17A, Cosentyx inhibits its action (ie. stops it from working as it usually does). This means Cosentyx interrupts the inflammatory cycle of psoriasis and psoriatic arthritis, which can lead to the improvement in symptoms for many people who take it.

Because of the effect Cosentyx has on the immune system, you will be monitored for infections throughout treatment, and you will be tested for latent (hidden) TB before starting treatment. People taking Cosentyx may need an annual flu jab, but should check with a doctor or nurse before having any other vaccinations or taking other medication.

How is Cosentyx used?

Cosentyx is taken as an injection under the skin, either via pre-filled syringe or pre-filled ‘pen device, similar to diabetes patients. A syringe or ‘pen’ holds 150 milligrams, but the recommended dose is 300 milligrams, meaning two injections should be taken at each dose. In the first four weeks, one dose (two syringes or ‘pens’) should be taken each week. After that, doses are taken monthly. Most people will be trained by a nurse to administer the injection themselves.

People taking Cosentyx are likely to need regular blood tests - usually carried out by Dermatology or Rheumatology Nurses, or by their own GP - to monitor for infections or other possible effects of the treatment.

If an adequate response is not seen after 12 weeks of using Cosentyx, the treatment will be stopped.

For more information on Cosentyx, have a read of our information sheet.