The National Institute for Health and Clinical Excellence has recommended the use of Genentech's clotbuster Activase (alteplase) for the treatment of acute ischaemic stroke on the National Health Service.
Activase is an enzyme (serine protease) that works by converting plasminogen to plasmin, a substance that rapidly breaks down the fibrin scaffolds of a blood clot, which helps to increase blood flow and thereby reduces the complications of stroke.
Each year in the UK, around 120,000 people have a first stroke, and 30% of die within a month. Stroke is also the single most common cause of severe disability in the country, with more than 250,000 people currently living with disabilities as a result, according to the Institute.
"We know that strokes are one of the biggest killers and causes of disability,” NICE’s Deputy Chief Executive, Andrea Sutcliffe, explained. “It is important that patients receive treatments that can help to reduce the effects of a stroke as quickly as possible. Today’s guidance recommending the use of alteplase where clinically appropriate has the potential to have a significant impact on the treatment of hundreds of thousands of patients.”
Temodal and Gliadel Wafer are in
Meanwhile, the Institute also issued guidance on the NHS use of Link Pharmaceutical's Gliadel Wafer (carmustine implant) and Schering-Plough's Temodal (temozolomide) for newly diagnosed high-grade glioma, a type of malignant brain tumour.
There are around 1,860 new cases of glioma are diagnosed in England and Wales each year and about 30% adult with the high-grade form survive for at least one year, while 13% live another five years.
Surgery followed by radiotherapy is the primary treatment, but NICE also recommends the use of: Temodal as an option for the treatment of newly-diagnosed patients with a World Health Organization performance status of 0 or 1; and Gliadel Wafer only for patients in whom 90% or more of the tumour has been surgically removed.
“This is a good use of NHS resources and it will ensure that patients who suffer from this rarer form of cancer are entitled to the same standard of care, regardless of where they live,” Sutcliffe said.
The Institute originally rejected the use of Temodal and Gliadel Wafer in February 2006 on grounds that they were not cost-effective, but was forced to re-think its decision after an error was found in the calculations behind the decision.