NICE re-thinks arthritis guidance
pharmafile | June 25, 2010 | News story | Sales and Marketing | Enbrel, Humira, MabThera, NICE, Orencia, Remicade, TNF, rheumatoid arthritis
NICE has approved five rheumatoid arthritis treatments in certain circumstances after treatment with a tumour necrosis factor inhibitor has failed.
In 2008 NICE said patients would not be able to try a second anti-TNF if their first attempt at anti-TNF therapy failed but this new guidance aims at giving patients a wider treatment choice.
The draft final guidance comes with a number of caveats. Roche’s MabThera, in combination with methotrexate, is approved as a treatment option for adults with severe active RA that has not responded well to other disease-modifying anti-rheumatic drugs (DMARDS), including treatment with at least one TNF inhibitor, or who are intolerant of other DMARDs.
The same caveat applies to Abbott’s Humira, Pfizer’s Enbrel, Merck’s Remicade and BMS’s Orencia, but they have an additional approval for patients with a contraindication to MabThera or methotrexate, or when either of these two treatments is withdrawn because of an adverse event.
NICE added that treatment with Humira, Enbrel, Remicade and Orencia should be continued only if there is an adequate response six months after the start of therapy.
Dr Carole Longson, director of NICE’s health technology evaluation centre, said: “The focus of this appraisal was to look at treatment options when a TNF inhibitor has not worked or when it has lost its effect. The evidence suggests that MabThera works in this context and is a cost-effective treatment option.
“However, not all patients are able to take MabThera, and so, following consultation, the appraisal committee has recommended that Humira, Enbrel, Remicade or Orencia may be given in this context if a patient cannot take MabThera.”
This will come as a boost for all five pharma companies but especially for Roche. The Swiss company has had several recent setbacks with RA treatments with the cessation of trials for ocrelizumab after safety concerns and cost-effectiveness for its RoActemra remains the final hurdle to receive NICE guidance.
Speaking to the BBC, Professor Alan Silman of Arthritis Research UK welcomed the news saying: “NICE’s decision will enable us to support both researchers and clinicians to move closer to what we regard as the medical equivalent of the Holy Grail – personalised medicine – with choice of treatment being more targeted and tailored towards individual needs.
“A major part of our research programme is to try and establish which patients will do best on which particular drug, and this decision will make that much more practically achievable.”
The full draft guidance can be found here.
Ben Adams
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