Diagnosis: Psoriasis
Issue under review: Otezla

Determination:
The Otezla is medically necessary.

The patient is an adult female with psoriasis covering the scalp, neck, ears and arms for whom Otezla is requested. She has tried and failed topical steroids and has been steadily worsening with now 10% BSA (body surface area) involved.

Since the patient is of childbearing age, use of methotrexate and acitretin are not medically appropriate. Additionally, they carry a much higher risk of adverse events, while not offering an advantage in efficacy. Cyclosporine is not an appropriate long term choice for treatment of psoriasis due to its side effect profile. It is generally used to initiate therapy while waiting for another agent to take effect. It is not appropriate as a single agent for long term use. Because of the location of the lesions in the scalp, phototherapy is not a reasonable option.

Otezla, an inhibitor of phosphodiesterase 4 (PDE4), is indicated for the treatment of adult patients with active psoriatic arthritis and patients with moderate to severe plaque psoriasis who are candidates for phototherapy or systemic therapy. (Celgene, 2015) Otezla is an oral small molecule inhibitor of phosphodiesterase 4 (PDE4) specific for cyclic adenosine monophosphate (cAMP) and is indicated for the treatment of adult patients with active psoriatic arthritis (PsA) as well as the treatment of patients with moderate to severe plaque psoriasis. (Celgene, 2016)

The patient has moderate to severe psoriasis for which therapy with Otezla is appropriate and medically necessary.

In view of the above, Otezla is medically appropriate and necessary.