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NICE backs one beta interferon for MS but rejects other drugs

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A beta interferon has been approved for the routine NHS treatment of some forms of multiple sclerosis, after a discount was agreed, but a further five drugs have been rejected.

The National Institute for Health and Care Excellence said today it had recommended that the drug Extavia, manufactured by Novartis, be available on the NHS in England.

“We are delighted that Novartis has been able to agree a reduction to the price of Extavia”

Carole Longson

In draft guidance it has backed the drug for the treatment of adults with relapsing- remitting MS or secondary progressive MS with continued relapses.

However, NICE concluded that four other beta interferons – Avonex, Betaferon, Plegridy and Rebif – plus the glatiramer acetate Copaxone were “not cost effective” at present.

Before the institute’s assessment all six drugs were available on the NHS through the Department of Health’s Risk Sharing Scheme (RSS) but that has now ended.

Patients with the long-term condition who are already being prescribed one of the five drugs not backed by NICE will be able to continue taking them.

But those who are newly diagnosed, or looking to change treatments, will not now be offered these options if NICE’s draft guidance is finalised after a five-week consultation exercise.

The draft document follows the Department of Health asking NICE to produce guidance on using beta interferons and glatiramer acetate in the NHS in England.

Extavia is a beta 1b interferon and is self-injected every two days. It slows down damage to the nervous system caused by MS and also by reducing the number of relapses.

It has a list price per patient per year of £7,259, but Novartis has agreed a confidential access scheme with the DH. The list prices of the other drugs per patient per year are:

  • Avonex £8,502
  • Copaxone £6,701
  • Betaferon £7,259
  • Rebif 22 £7,513
  • Rebif 44 £10,572
  • Plegridy £8,502

Professor Carole Longson, director of NICE’s centre for health technology evaluation, said: “We are delighted that Novartis has been able to agree a reduction to the price of Extavia to allow it to be made routinely available to people with this type of multiple sclerosis.”

However, she indicated that NICE was open to working with the other pharmaceutical companies that made MS drugs if prices were to come down.

She said NICE was “keen” to work with the other drug firms “to ensure that patients continue to benefit from a choice in treatment for multiple sclerosis”.

Professor Carole Longson

Professor Carole Longson

Carole Longson

However, there was dismay from MS charities at the recommendations in the draft guidance. The MS Trust criticised the decision arguing that NICE had found all six drugs to be equally effective at reducing the number of relapses and slowing down disability progression.

The charity claimed NICE’s decision to support only Extavia was down to cost alone and took no account of how different treatments suited different patients or of differing tolerances to individual drug side effects.

Meanwhile, the MS Society estimated around 9,100 people in England were receiving treatments which will not be available to future patients under the new guidance as it stands – comprising about 42% of all MS prescriptions.

If the proposals were to go ahead, 1,450 newly diagnosed patients each year could be denied what would otherwise be their treatment of choice, the charity argued.

“We strongly believe that all current treatments should remain available as an option for all eligible patients”

David Martin

David Martin, chief executive of the MS Trust said he was “very disappointed” with NICE’s recommendation.

“We strongly believe that all current treatments should remain available as an option for all eligible patients. NICE’s decision is based on price and does not acknowledge the individual reasons why people with MS might choose these drugs,” he said.

He added that the timing of the consultation – starting just before Christmas – was also problematical.

“We are now actively seeking feedback from people living with MS and MS nurses about what these recommendations could mean for them,” he said.

MS affects about 116,000 people in England, around 40,000 of whom have relapsing-remitting MS. This is where people have distinct symptoms, such as vision problems or difficulty keeping balance, which then fade away either partially or completely.

Relapsing-remitting MS is followed by secondary progressive MS where the disability steadily gets worse.

NICE has invited comments on its draft recommendation. The closing date for feedback is 24 January 2018.

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