Scotland's SMC backs use of Roche's Actemra, a drug still not allowed in England NHS

In final draft guidance published yesterday, the Scottish Medicines Consortium has accepted the restricted use of Swiss drug major Roche's Actemra (toculizumab) within the National Health Service in that country. The agency's approval states: 'Despite [some] uncertainties it was considered that a sufficiently robust economic case for tocilizumab has been presented for acceptance by the SMC.'

Licensed indication under review by the SMC are in combination with methotrexate, for the treatment of moderate-to-severe active rheumatoid arthritis in adult patients who have either responded inadequately to, or who were intolerant to, previous therapy with one or more disease-modifying anti-rheumatic drugs or tumor necrosis factor antagonists. In these patients, toculizumab can be given as monotherapy in case of intolerance to methotrexate or where continued treatment with methotrexate is inappropriate.

It is restricted for use in combination therapy within NHS Scotland, as the manufacturer did not present an economic case for monotherapy, said the agency. Toculizumab should be used in accordance with the British Society of Rheumatology guidelines for prescribing TNF-a blockers in adults, it added.