Charity groups have been pleasantly surprised by the news that the UK's NICE has endorsed the use of Roche’s MabThera for rheumatoid arthritis and Abbott's Humira for psoriatic arthritis.
NICE has published final guidance on the use of Mabthera (rituximab) and Humira (adalimumab) and said that the former, in combination with methotrexate, is recommended as a treatment option for adults with severe active rheumatoid arthritis who have had an inadequate response to or intolerance of other disease modifying anti-rheumatic drugs, including at least one anti-TNF therapy. It added that treatment should be continued only if there is an adequate response following initiation of therapy.
Adalimumab is now recommended for adults with active and progressive psoriatic arthritis when the person has three or more tender joints and three or more swollen joints, and the disease has not responded to at least two standard disease-modifying anti-rheumatic drugs. Treatment with adalimumab should be discontinued after 12 weeks in adults whose psoriatic arthritis has not shown an adequate response, NICE added.
The latter’s chief executive Andrew Dillon said that “following further clarification from the manufacturer on the economic analysis of rituximab”, the committee has assessed that “these drugs represent the right approach for the NHS to take in the treatment of two severe forms of arthritis”. He added that up to 1% of the population suffers from rheumatoid or psoriatic arthritis, “which are both very distressing, causing a great deal of pain or discomfort and impacting on an individual's ability to go about their daily life” and the approval of both of these drugs is good news."
The news comes less than three weeks after NICE issued draft guidance rejecting Bristol-Myers Squibb’s Orencia (abatacept) for rheumatoid arthritis. That decision was met with dismay by the UK charity Arthritis Care but the latest decision on MabThera was described by its chief executive Neil Betteridge as “a triumph”. He added that “the search for effective treatment can be a long, agonising journey, littered with dashed hopes. Now there's no excuse to deny this drug on anything but clinical grounds”.
He added that “NICE has shown that it understands the benefit of expanding the range of choices for individuals who have exhausted other options, and would otherwise face the bleak prospect of palliative care, and a return to drugs that have already failed them”. Mr Betteridge concluded by acknowledging that “anti-TNF drugs don’t work for everyone” but left untreated, “the disease can be severely disabling, so pinpointing the right drug is a race against time to match a given individual to what's most suitable, so the more options available, the better'.
Rituximab is already available in Scotland in accordance with a decision by NICE’s counterpart north of the border, the Scottish Medicines Consortium, whilst Northern Ireland usually follows NICE’s guidance.