NICE updates its recommendation on Tremfya (Guselkumab) for psoriatic arthritis

The updated recommendation should make the biologic treatment more accessible to adults with psoriatic arthritis in England and Wales.

Following a recent rapid review, The National Institute for Health and Care Excellence (NICE) has updated its recommendation on the biologic medicine, Tremfya (also known by its generic name, Guselkumab), for the treatment of psoriatic arthritis in England and Wales.

NICE originally published its decision to recommend Tremfya as a treatment option for adults with active psoriatic arthritis in June 2021. As a result of the recent review of its recommendation, Tremfya should now be more accessible than it was previously.

The updated guidance states that Tremfya, alone or with methotrexate, is recommended as an option for treating active psoriatic arthritis in adults whose condition has not responded well enough to disease-modifying antirheumatic drugs (DMARDs) or who cannot tolerate these treatments. It is recommended only if the individual has:

• Already had 2 conventional DMARDs and at least 1 biological DMARD, or;
• Biologics from the tumour necrosis factor (TNF)-alpha inhibitor class are contraindicated (should not be used in this case) but would otherwise be considered (as described in NICE's technology appraisal guidance on etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis).


Active psoriatic arthritis is defined as peripheral arthritis with 3 or more tender joints and 3 or more swollen joints.

This update to the guidance means that a previous requirement for the individual to have moderate to severe psoriasis (a body surface area of at least 3% affected by plaque psoriasis and a Psoriasis Area and Severity Index [PASI] score greater than 10) is no longer part of the criteria for adults with psoriatic arthritis to be offered Tremfya.

How does Tremfya work?

Tremfya blocks the activity of interleukin 23 (IL-23), a chemical ’messenger’ in the immune system that signals other cells to cause inflammation. In people with psoriasis or psoriatic arthritis, the immune system is overactive and creates too much inflammation, which leads to the development of psoriasis and/or psoriatic arthritis symptoms. By blocking IL-23, Tremfya aims to prevent some of that inflammation from occurring, leading to an improvement in psoriasis and psoriatic arthritis for some people who take it.

There is currently one other biologic medication that blocks the activity of IL-23 available for people with psoriatic arthritis, called Stelara (Ustekinumab).

How is Tremfya used?

Individuals take Tremfya at home by giving themselves an injection under the skin via a pre-filled syringe. Most people will be trained by a nurse to give the injection to themselves. The second dose is taken four weeks after the first, but after that Tremfya is usually taken every eight weeks.

People taking Tremfya will have regular blood tests every three to six months - usually carried out by Rheumatology Nurses, or by their own GP - to monitor for infections or other possible effects of the treatment. People taking Tremfya are more at risk of infections and so should be vaccinated against pneumonia and have an annual flu vaccination. However, not all vaccinations are safe in people taking Tremfya; ‘live’ vaccinations should be avoided. Check with a doctor or nurse before having any vaccinations or taking other medication if you are not sure.

For more information about Tremfya, have a read of our information sheet.