Post-market Review of the use of biologics in the treatment of severe chronic plaque psoriasis

Page last updated: 25 July 2017

Background

Biologics are a group of anti-inflammatory and immune-suppressing agents that are used to treat rheumatoid arthritis and other autoimmune diseases including Crohn’s disease, ankylosing spondylitis, psoriatic arthritis and severe chronic plaque psoriasis.

In June 2014, the Drug Utilisation Sub-Committee (DUSC) of the Pharmaceutical Benefits Advisory Committee (PBAC) reviewed the Pharmaceutical Benefits Scheme (PBS) utilisation of bDMARDs medicines and referred the matter to the PBAC for information.

In March 2015, the PBAC considered the submission for secukinumab for severe chronic plaque psoriasis and noted that etanercept was the main comparator for the current PBS biological Disease Modifying Anti-Rheumatic Drugs (bDMARDs) psoriasis listings. PBAC noted that there is emerging evidence of variation in response to Tumour Necrosis Factor-alpha (TNF-α) inhibitors in psoriasis, with etanercept appearing to be less effective than other agents. The PBAC recommended to the Minister that a cost-effectiveness review of the bDMARDs for severe chronic plaque psoriasis be undertaken.

The Review was recommended by the PBAC at its December 2015 meeting and approved by the Minister for Health on 7 April 2016.

At its August 2016 meeting, the PBAC endorsed the final Terms of Reference (ToR) and altered the name of the Review from ‘bDMARDs’ to ‘biologics’ in response to stakeholders’ comments that these drugs are not anti-rheumatic drugs, but biological drugs for the treatment of psoriasis and psoriatic arthritis. 

The Post-market Review will re-assess the cost-effectiveness of biologics used in the treatment of severe chronic plaque psoriasis, in the context of the latest available evidence and best clinical practice.

The Review is being carried out under the Australian Government’s post-market monitoring program, which aims to ensure the continued safe, cost-effective and quality use of medicines listed on the PBS.

Medicines included in the biologics for severe chronic plaque psoriasis Review are:

  • adalimumab
  • etanercept
  • infliximab
  • ustekinumab
  • secukinumab
  • ixekizumab

Public Consultation on the draft Terms of Reference (Closed)

Public consultation on the draft Review Terms of Reference closed on 16 May 2016.  To view submissions please go to the Public Consultation page.

Final Terms of Reference

The Final Review Terms of Reference are:

  1. Review current clinical guidelines for the treatment of severe chronic plaque psoriasis and compare to the Pharmaceutical Benefits Scheme (PBS) restrictions for use of biologics in this indication.
  2. Review and evaluate recent clinical evidence on the efficacy and safety of biologics used in the treatment of severe chronic plaque psoriasis and compare to the evidence considered by Pharmaceutical Benefits Advisory Committee (PBAC) in previous sponsor submissions.
  3. Review the utilisation of PBS biologics for the treatment of chronic plaque psoriasis including time on treatment and discontinuation from treatment, and compare this with that observed in the clinical trial evidence considered by the PBAC.
  4. Subject to the findings from Terms of Reference 1, 2 and 3, review the cost-effectiveness of biologics for severe chronic plaque psoriasis.

Consultation on the Review

Public consultation addressing the Review and final Terms of Reference closed on 15 February 2017.

Submissions are published on the public consultation page for the post-market review of biologics for the treatment of severe chronic plaque psoriasis.

Stakeholder Forum

A Stakeholder Forum will be held in Melbourne on 20 October 2017 to provide a further opportunity to contribute to the Review. Consumers of biological medicines listed on the PBS for severe chronic plaque psoriasis, clinicians and pharmaceutical sponsors have been invited to participate.

Please note that attendance is by invitation only. If you believe that your contribution is integral to inform the Stakeholder Forum, and you have not yet received an invitation, please email the Review’s Secretariat.

Review Process

This Review will follow the steps in the Post-market Review Framework. This process includes public consultation on the draft Terms of Reference, an opportunity to provide submissions to the Review, and an opportunity to comment on the draft Review Report.

Further Information

Further information on post-market reviews is available on the Post-market Reviews web page.

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