ICER: IL-23 Inhibitors Are Preferable to Anti-TNF Agents for Plaque Psoriasis

The Institute for Clinical and Economic Review (ICER) released a Final Condition Update report and a Report-at-a-Glance on immunomodulators for the treatment of moderate to severe plaque psoriasis.

The updated report incorporates new clinical data and cost information for therapies that have been previously reviewed, as well as analyses of more recently approved medications such as guselkumab (Tremfya), tildrakizumab (Ilumya) and certolizumab pegol (Cimzia). Also included within the report were data on risankizumab, which is currently under review by the FDA.

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At a July 2018 public meeting of the New England Comparative Effectiveness Public Advisory Council, the group voted that, compared with anti—tumor necrosis factor (anti-TNF) drugs, both guselkumab and risankizumab offered a superior benefit based on currently available data.

“Similar to the findings of our 2016 report, we again found that many targeted therapies offer benefit over non-targeted therapies, and we are able to further clarify which agents may be most effective,” said Dan Ollendorf, PhD, ICER’s Chief Scientific Officer in a statement.

In addition to the clinical benefits of these medications, ICER recognized that these therapies appear to reduce complexity of care, reduce burdens on family members and caregivers, and improve patients’ ability to work. The report also noted that these therapies use a novel mechanism of action, which allows for new treatments to be effective for patients for whom previous therapies have failed.

However, ICER noted that the evidence was not adequate to show a net health benefit of tildrakizumab compared with anti-TNF agents, or of the anti-TNF agent certolizumab pegol over other subcutaneously administered TNF inhibitors, such as adalimumab (Humira) and etanercept (Enbrel).

Based on the findings of the report, ICER updated its policy recommendations to say that insurers should consider the limitation or cancellation of step therapy approaches to coverage for these drugs, as patients and clinicians have reiterated that step therapy delays improvements to patients’ quality of life. Manufacturers, it adds, should be transparent in the rationale for any increases in drug prices.

“While many of these therapies currently represent reasonable value, patients continue to face insurance barriers that interfere with their access to these potentially life-changing therapies, and recent price increases for many agents may further limit access,” said Ollendorf.