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NICE provisionally backs drugs for arthritis in children

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Four drugs for treating a form of arthritis in children and young people have been provisionally recommended by the National Institute for Health and Care Excellence in final draft guidance.

NICE has provisionally recommended abatacept (Orencia), adalimumab (Humira), etanercept (Enbrel) and tocilizumab (RoActemra) as options for treating juvenile ideopathic arthritis.

“We are pleased to be able to recommend these drugs as options for children and young people with juvenile idiopathic arthritis in today’s draft guidance”

Carol Longson

Specifically they are recommended as options for treating polyarticular juvenile idiopathic arthritis, including polyarticular-onset, polyarticular-course and extended oligoarticular juvenile ideopathic arthritis.

The four treatments covered by the draft guidance are disease-modifying anti-rheumatic drugs. They are all licensed for use where previous treatment has been associated with an inadequate response or with intolerance.

The draft guidance states that when more than one drug is suitable, treatment should be started with the least expensive drug, taking into account administration costs, the dose needed and the product cost per dose.

The condition, which involves joint inflammation that lasts for more than six weeks, affects around 10,000 children and young people in the UK.

It has no known cause and may start with symptoms such as a fever or rash, with joints eventually becoming swollen and inflamed.

In more severe cases, it can cause growth impairment, joint contractures, joint disease requiring joint replacements, eye problems, inflammatory bowel disease and psoriasis.

The aims of treatment are to control joint pain and inflammation, reduce joint damage, disability and loss of function and maintain or improve quality of life.

However, about a third of children with juvenile ideopathic arthritis will not achieve remission from the condition and will need further rheumatological care as adults.

Professor Carole Longson, director of the NICE Health Technology Evaluation Centre, said: “Juvenile idiopathic arthritis is a progressive degenerative condition that not only affects the quality of life of the child or young person with the disease, but can also affect the quality of life of their carers and family.

“We are therefore pleased to be able to recommend these drugs as options for children and young people with juvenile idiopathic arthritis in today’s draft guidance,” she said.

The draft guidance is now with consultees, who have the opportunity to appeal against it util 5 November.

Once NICE issues its final guidance on the technology, which is expected in February next year, it will replace local recommendations across the country.

 

Summary of the draft recommendations:

  • Abatacept – people six years and older whose disease has responded inadequately to other DMARDs, including at least one tumour necrosis factor (TNF) inhibitor
  • Adalimumab – people two years and older whose disease has responded inadequately to one or more DMARD
  • Etanercept – people two years and older whose disease has responded inadequately to, or who are intolerant of, methotrexate
  • Tocilizumab – people two years and older whose disease has responded inadequately to previous therapy with methotrexate
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