NICE is recommending the blood thinner Eliquis in its final piece of guidance released today, just three months after receiving approval for use in Europe.
The watchdog is recommending Pfizer and Bristol Myers Squibb’s oral anticoagulant Eliquis (apixaban) as an option for preventing stroke and systemic embolism within its marketing authorisation, that is, in people with non-valvular atrial fibrillation (AF) with one or more risk factors.
The NICE appraisal committee said that Eliquis was cost effective and more clinically effective for reducing stroke and systemic embolism and resulted in fewer bleeds than warfarin, the established standard of care.
Eliquis has been fast-tracked by NICE to go straight to final guidance, which should shorten its journey into NHS funding. A final decision is expected in February and once the final guidance is published, the NHS will be legally obliged to implement it within 90 days.
There are already two oral anticoagulants available for NICE funding: Boehringer’s Pradaxa and Bayer/Janssen’s Xarelto, both of which came to the market long before Eliquis.
NICE said in March last year that Pradaxa could be used as an option for the prevention of stroke and systemic embolism in people with atrial fibrillation. But the drug now comes with additional safety warnings, and NICE also recommended that doctors should discuss other treatment options with their patients.
Xarelto received a similar recommendation in May, and also has NICE’s backing to treat patients with certain blood clots.
Atrial fibrillation is the most common heart rhythm disorder and is thought to cause around 12,500 strokes in the UK every year. Traditionally the NHS has used warfarin to treat patients with AF who at risk of stroke.
Although very cheap, warfarin can cause bleeding and interact with other medicines and food, and can also require many attempts to find the right dose.
These new anticoagulants have fewer interactions and can cause less bleeds than warfarin, but are far more expensive than the now generic drug.
Amadou Diarra, VP for UK and Ireland at Bristol-Myers Squibb, said: “NICE’s fast-tracked recommendation confirms the value of apixaban as a cost-effective oral anticoagulant for the prevention of stroke in patients affected by atrial fibrillation. The risk of stroke in these patients is a serious public health concern and through this new treatment option, the Alliance of Bristol-Myers Squibb and Pfizer remains committed to helping reduce the incidence of stroke in patients living with non-valvular AF.
“We look forward to working with the NHS and other partners to ensure that, where clinically appropriate, patients are provided with rapid access to apixaban, which has been shown to prevent strokes, reduce bleeds and be potentially life-saving compared to the current standard of care, warfarin.”