Within weeks of positive guidance from NICE on Elan and Biogen's Tysabri (natalizumab), the Scottish Medicines Consortium yesterday issued similar advice recommending the restricted use of the drug in people with highly active relapsing remitting multiple sclerosis.

"Access to appropriate therapy is particularly vital in Scotland as we have the highest number of people with MS per capita in the world," commented Dr Belinda Weller, Western General Hospital, Edinburgh. "Our priority now must be to ensure that treatment is made available to those with the most highly active form of the disease." Highly active RRMS is defined as two or more disabling relapses in one year and an active MRI scan.

The first treatment to be specifically licensed for highly active RRMS, Tysabri has been shown to lead to a 64% reduction in the risk of disability progression and an 81% reduction in annualised relapse rate compared with placebo over two years.

Elan/Biogen estimates the direct impact of Tysabri on NHS Scotland's budget at £4.19 million by year five, based on 284 patients treated, with a net budget impact of £1.72 million, although the SMC considers the figures likely to be an underestimate. Jeanette Marchant