OBJECTIVES: To check clinical compliance with guidance specified by NICE Technology Appraisals 103 (etanercept & efalizumab1), 134 (infliximab2) and 146 (adalimumab3). METHODS: A retrospective audit of medical records of patients treated with biologics for psoriasis, since issue of relevant NICE guidance in 6 UK Dermatology centres.  The audit was conducted between December 2008 and February 2009 in accordance with a standardised protocol and data collection form, with local management approval to release anonymised data for pooled analysis. RESULTS: A total of 173 courses of biologic treatment (in 149 patients) were included in the audit. PASI and DLQI were recorded at initiation of 96% (n=166) of treatments.  Biologics were initiated for appropriately severe disease in 92% of cases (n=159) and only after failure, intolerance or contra-indication to standard systemic therapies in 98% (n=170) of cases.  In 69% (n=120) of cases, PASI and DLQI were recorded at the appropriate review dates (10, 12 or 16 weeks, depending on biologic).  Etanercept was prescribed at the licensed dose of 50mg weekly in 92% of cases (n=120) but was discontinued appropriately in responders before week 24 in only 6.5% (n= 3 of 45). Only 37% of cases with an inadequate response to biologics at the appropriate review date (n= 50 of 135), had therapy withdrawn. CONCLUSIONS: In the 6 sites audited, compliance with national guidance was entirely appropriate for the commencement and dosing of biology therapy. However, the requirement to discontinue etanercept in responders was rarely followed. Similarly, discontinuation of biologics in non-responders was not routine practice.  These results indicate that despite guidance to the contrary etanercept is used continuously in practice in these specialist centres. This may indicate a reluctance of both patients and clinicians to withdraw an at least partly effective therapy in these refractory patients. Review of this aspect of NICE guidance may be warranted.