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NICE limits rheumatoid arthritis drugs to severe disease

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The National Institute for Health and Care Excellence has recommended a raft of new drugs for the treatment of rheumatoid arthritis, but only when the condition is severe.

In final updated guidance published today, NICE recommends seven biological disease modifying drugs as options for treating severe rheumatoid arthritis, which has not responded to intensive therapy with a combination of conventional disease-modifying anti-rheumatic drugs.

“This guidance reaffirms our previous recommendations on these drugs”

Carole Longson 

However, the guidance does not recommend their use for treating moderate active rheumatoid arthritis. Publication of the guidance follows unsuccessful appeals against the draft guidance.

The guidance recommends adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade, Inflectra or Remsima), certolizumab pegol (Cimzia), golimumab (Simponi), tocilizumab (RoActemra) and abatacept (Orencia), each in combination with methotrexate.

Adalimumab, etanercept, certolizumab pegol or tocilizumab are also recommended as monotherapy for people who cannot take methotrexate.

In the case of certolizumab pegol, golimumab, abatacept and tocilizumab the recommendation is subject to the companies providing them as agreed in their patient access schemes.

The guidance states that treatment should be started with the least expensive drug (taking into account administration costs, dose needed and product price per dose).

The guidance also includes recommendations about when treatment with biological DMARDs should be continued or withdrawn.

Professor Carole Longson, director of the Health Technology Evaluation Centre at NICE, said: “This guidance considers at what stage it’s clinically and cost effective to start using biological therapies as treatment options for adults with rheumatoid arthritis.

“In recommending them as options for people with severe rheumatoid arthritis after previous treatment with conventional DMARDs has been unsuccessful, this guidance reaffirms our previous recommendations on these drugs and confirms their place as an integral part of the rheumatoid arthritis treatment pathway,” she said.

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