This week, NICE has published three recommendations that could “drastically limit” the treatment options available to patients with severe rheumatoid arthritis (RA).
NICE’s latest ruling against funding tocilizumab (RoActemra) comes only a day after a negative decision on abatacept (Orencia) as a second-line treatment and restrictions were placed on the use of three other anti-TNF drug therapies (adalimumab, etanercept and infliximab).
The National Rheumatoid Arthritis Society (NRAS) has condemned these decisions, which it says “drastically” limit treatment options for people with severe RA.
Ailsa Bosworth, Chief Executive of NRAS, said: “If NICE’s recommendations become final guidance, patients with severe RA who have failed on previous anti-TNFs will only have access to rituximab in the NHS and only very restricted access to a second anti-TNF.
“NICE seem not to understand that RA is not a one size fits all disease. With such limited treatment options, some patients will be left with the unacceptable choices of being put back onto treatments they have already failed on, or taking large doses of steroids which have extremely unacceptable side effects such as osteoporosis when given over the long term.”
RA is a lifelong, progressive disease characterised by inflammation and swelling of joints, leading to deformity, functional impairment, pain, fatigue and ultimately disability. Around 30% of RA patients fail to respond adequately or will be intolerant to a first anti-TNF therapy and the current only alternative, rituximab, does not achieve an effective response in up to 50% of patients.
If NICE’s latest guidance on abatacept and anti-TNF therapies is adopted, rituximab will be the only option open to patients following unsuccessful therapy with DMARDs or an anti-TNF.
Due to a successful appeal by the NRAS against an earlier decision, this is the second time that NICE has reviewed the effectiveness of switching between anti-TNF therapies, a tactic that many patients have found effective.
The ruling is that adalimumab, etanercept and infliximab should only be used following the failure of a previous TNF inhibitor in the context of research. NICE has maintained that there is insufficient evidence of the benefit or cost-effectiveness of switching patients to a second anti-TNF.
Dr Chris Deighton, Consultant Rheumatologist at Derbyshire Royal Infirmary, said: “Patients who fail on their first anti-TNF already have very bad rheumatoid arthritis and deserve more choice than just rituximab. We will be doing our best to ensure that the final appraisal offers more treatment options for patients.”
Ailsa Bosworth concluded: “We simply cannot accept that individuals should be denied the chance of at least regaining some quality of life and condemning them to a life of pain and disability, which could be as or even more expensive to the NHS as well as society as a whole if people, as a consequence of not being able to access clinically effective therapies, lose their jobs.”