NICE publishes draft guidance on rheumatoid arthritis drugs after initial anti-TNF use
Published on 05 Mar 2010
The National Institute for Health and Clinical Excellence (NICE) has published preliminary recommendations on the management of rheumatoid arthritis after initial treatment with an anti-TNF drug has failed.
Firstly, NICE has recommended that rituximab (MabThera) may be used in combination with methotrexate in adults who have previously tried other disease-modifying anti-rheumatic drugs (DMARDs) and at least one anti-TNF therapy.
Rituximab may also be offered to patients who are unable to take other DMARDs because of unwanted side-effects.
Secondly, patients should only be offered the anti-TNF drugs adalimumab, etanercept and infliximab after failing to respond to a previous anti-TNF drug if they are taking part in a clinical trial.
Finally, NICE has recommended that abatacept (brand name Orencia) - which works by interfering with the T-cell response - should not be given to rheumatoid arthritis patients who have previously tried an anti-TNF drug.
Dr Carole Longson, director of the institute's Health Technology Evaluation Centre, noted that the appraisal only looked at these drugs in the context of people who have already used an anti-TNF drug.
She revealed: "The evidence suggests that rituximab works in this context and is a cost-effective treatment option.
"There was limited evidence available to the appraisal committee on the clinical effectiveness of using a second TNF inhibitor (adalimumab, etanercept or infliximab) after a first one had failed. Given the limited evidence base, the appraisal committee felt that further research is needed into the clinical effectiveness of these drugs in this context."
Dr Longson added that abatacept does not appear to work any better than rituximab in this context - and is more expensive - prompting the committee to conclude that it would not be good value for money.
The preliminary recommendations are now open for public consultation until March 24th 2010, after which NICE's appraisal committee will consider the responses before publishing its next draft guidance.
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