DORSET MEDICINES ADVISORY GROUP

COMMISSIONING STATEMENT ON RISANKIZUMAB FOR TREATING MODERATE TO SEVERE PLAQUE

SUMMARY NHS Dorset Clinical Commissioning Group recommends risankizumab alone, or with methotrexate, for treating moderate to severe plaque psoriasis in adults, only if: • the disease is severe, as defined by a total Psoriasis Area and Severity Index (PASI) of 10 or more and a Dermatology Life Quality Index (DLQI) of more than 10 and • the disease has not responded to other systemic treatments, including ciclosporin, methotrexate and phototherapy, or these options are contraindicated or not tolerated Risankizumab is only recommended if the company provides it according to the commercial arrangement.

The dosage recommendation is as follows: 150 mg by subcutaneous injection (2×75 mg injections) at week 0 and 4, and then every 12 BACKGROUND weeks thereafter. Consideration should be given to stopping treatment in patients whose disease has shown no response after 16 weeks of treatment.

RELEVANT NICE NICE TA596: Risankizumab for treating moderate to severe plaque GUIDANCE psoriasis

FORMULARY STATUS Red

PBR STATUS Excluded from PBR tariff

Represents an additional option within the locally agreed pathway.

COMMISSIONING NICE already recommends TNF-alpha inhibitors (that is, , IMPLICATIONS etanercept and ), , , , , , , and for treatment of adults with psoriasis.

RELEVANT CLINICAL Commissioned by Clinical Working Group of DMAG and dermatology WORKING GROUP workstream of Elective Care

If patients and their clinicians consider risankizumab to be one of a PATIENT PATHWAY range of suitable treatments the least expensive (taking into account IMPLICATIONS administration costs and patient access schemes) should be chosen.

Risankizumab is proposed as an alternative to other biological therapies already recommended by NICE for treating severe plaque SUMMARY OF psoriasis in adults. Evidence from clinical trials shows that risankizumab EVIDENCE TO is more effective than adalimumab and ustekinumab. Indirect SUPPORT comparisons suggest that risankizumab is likely to provide similar FORMULARY STATUS health benefits compared with guselkumab, and better PASI response rates compared with many other biologicals.

1 For the cost comparison, it is appropriate to compare risankizumab with guselkumab. The total costs associated with risankizumab are similar to or lower than those associated with guselkumab. Therefore, risankizumab is recommended as an option for use in the NHS for severe plaque psoriasis that has not responded to systemic non- biological treatments, or if these are contraindicated or not tolerated.

£3,326.09 per 2x 75‑mg syringe pack.

ASSESSMENT OF The company has a commercial arrangement. This makes risankizumab COST IMPLICATIONS available to the NHS with a discount. The size of the discount is commercial in confidence. It is the company's responsibility to let relevant NHS organisations know details of the discount.

NICE TA596: Risankizumab for treating moderate to severe plaque REFERENCES psoriasis

DATE August 2019

REVIEW DATE July 2021

CONTACT FOR THIS Michelle Trevett, Senior Pharmacist, NHS Dorset CCG POLICY

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