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College to fight NICE restrictions on rheumatoid arthritis drug options

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The RCN is to appeal against a draft ruling by NICE that could deny patients with rheumatoid arthritis access to treatment alternatives.

The college has warned that it may call for a judicial review if the institute does not back down on a decision to deny NHS patients in England and Wales the option of alternative anti-TNF drugs if an initial course of treatment fails.

Currently if a patient fails to respond to an anti-TNF drug – adalimumab, etanercept or infliximab – clinicians can try another.

But in a final appraisal determination, published last month ahead of guidance expected later this year, NICE said this practice should cease (NT News, 29 July, p8).

Instead, if an initial anti-TNF course fails, treatment will be stopped and access to alternative drugs from the class denied.

Patients will then be moved to another drug, rituximab, which is cheaper.

Nurses have criticised the decision as a short-term, cost-saving measure.

Sue Thomas, RCN long-term conditions adviser, said: ‘What we are saying is that patients should be given the opportunity to try other anti-TNF drugs. Everybody is really concerned.

‘The costs are going to be on nurses and the rest of the NHS if somebody becomes disabled because they have not been given the appropriate treatment,’ she added.

Susan Oliver, chief nurse adviser to the National Rheumatoid Arthritis Society, said: ‘We have learnt a lot about these drugs over the last 10 years. We have worked hard to collect data and recognise that these drugs have some immense benefits to patients.

‘Patients are going to feel real pressure deciding which is the right one for them when they don’t get another option,’ she warned. ‘It is very stressful for the patient and very frustrating for the nurse.’

Last week NICE was further criticised over a final appraisal determination that would deny the use of four drugs for advanced kidney cancer – bevacizumab, sorafenib, sunitinib and temsirolimus.

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