NICE issues final guidance recommending seven drugs for RA

In final updated guidance published today, UK medicines cost-effectiveness watchdog the National Institute for Health and Care Excellence (NICE) recommends a number of drugs called biological disease modifying drugs (DMARDs) as options for treating severe rheumatoid arthritis which has not responded to intensive therapy with a combination of conventional DMARDs.

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 Publication of the guidance follows unsuccessful appeals against the draft guidance.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, from AbbVie [NYSE: ABBV]), etanercept (Enbrel, from Pfizer [NYSE: PFE]), infliximab (Remicade, from Merck & Co [NYSE: MRK]), the infliximab biosimilars Inflectra from Hospira and Remsima, Napp Pharmaceuticals ), certolizumab pegol (Cimzia, from UCB [Euronext: UCB]), golimumab (Simponi, from Merck & Co), tocilizumab (RoActemra, from Roche [ROG: SIX]) and abatacept (Orencia, from Bristol-Myers Squibb [NYSE: BMY]), 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.

Treatment should start with least expensive drug

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The guidance also includes recommendations about when treatment with biological DMARDs should be continued or withdrawn.

The disease affects around 400,000 people in the UK, of whom around 15% have severe disease. It is about two–four times more common in women than in men. It can develop at any age, but the peak age of onset in the UK is about 40–70 years. Rheumatoid arthritis is associated with increased mortality and increasing disability and can have a severe effect on quality of life.

“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,” commented Carole Longson, director of the Health Technology Centre at the NICE.