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NICE backs more treatment options for spinal arthritis

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Guidelines published by the National Institute for Health and Care Excellence today have recommended the expanded use of a class of drugs for treating adult axial spondyloarthropathy.

NICE has published final guidance that recommends treatments for types of arthritis that affect the spine, including a raft of drugs known as TNF-alpha inhibitors.

“We are delighted that these guidelines support improved access to treatment”

Debbie Cook

NICE has backed adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade, Inflectra or Remsima), certolizumab pegol (Cimzia) and golimumab (Simponi).

As well as re-affirming previous NICE guidance recommending adalimumab, etanercept and golimumab as treatment options for adults with ankylosing spondylitis, the guidance also recommends infliximab and certolizumab pegol as additional treatment options.

Non-radiographic axial spondyloarthritis is also covered by the guidance and adalimumab, certolizumab pegol and etanercept are recommended as treatment options for adults with this condition.

The updated recommendations state that the choice of therapy should take into account any associated conditions including extra-articular manifestations (EAMs) and should involve discussion with patients on the best option for them.

In people with the condition, the predominant symptom is back pain with inflammation of the sacroiliac joints. However, there may also be peripheral joint involvement or EAMS such as uveitis, inflammatory bowel disease and psoriasis involved.

NICE now also recommends switching to another TNF-alpha inhibitor in adults whose disease does not respond or stops doing so after an initial response.

Once NICE issues final positive guidance, the NHS has a legal obligation to begin funding the treatment for eligible patients within three months.

Debbie Cook, chief executive of the charity the National Ankylosing Spondylitis Society, said: “We are delighted that these guidelines support improved access to treatment, something which we have campaigned for over many months.

“We hope that the recommendations will enable broader and earlier access to TNF-alpha inhibitors, taking into account other associated conditions and allowing people to have more say in their treatment,” she said.

“Permitting treatment switching is also good news for patients as it reduces the fear and anxiety associated with only having one option,” she added.


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