The cost watchdog for the National Health Service has changed its opinion on the use of certain rheumatoid arthritis drugs and the cycling of anti-TNF therapies, giving patients wider access to treatments.

New draft guidance published by the National Institute for Health and Clinical Excellence not only promises to fund certain drugs previously ousted but also removes the ban on cycling anti-TNF drugs, thus significantly widening the treatment options for patients.

NICE is proposing that Roche’s MabThera (rituximab), in combination with methotrexate, can be used for the treatment of adult patients severe active rheumatoid arthritis that have failed to responded to other disease-modifying anti-rheumatic drugs (DMARDs), including at least one TNF inhibitor, or when patients are unable to tolerate other DMARDs.

As well as Abbott’s Humira (adalimumab), as well as Schering-Plough’s Remicade (infliximab), Wyeth’s Enbrel (etanercept) and Bristol Myers-Squibb’s Orencia (abatacept) have also now been recommended as options in the same circumstances after being previously rejected, but only if patients cannot take MabThera/methotrexate, as these drugs come with much higher price tags.

The annual acquisition cost of MabThera is around £3,492 for one course to £6,984 for two courses per year, while Humira and Enbrel are £9,295 each, Remicade costs £10,072 in the first 12 months and between £7,553 - £8,812 in subsequent years, and Orencia, being the most expensive, £10,171 in the first year and £9,444 annually thereafter.

Because of their relatively high cost, the Institute has stipulated that therapy with each of these drugs is only continued if a significant improvement is seen within six months, but the proposals overall are good news for the 87,000 patients with severe rheumatoid arthritis in England and Wales, as it provides them with a much wider choice of treatments to manage their disease.

“Different people respond in different ways to treatment and the committee heard from clinical experts and patients about the importance of having multiple options available,” explained Carole Longson, director, Health Technology Evaluation Centre at NICE.

'Holy grail'
Arthritis Research UK has welcomed the Institute’s change of heart, following a successful appeal from arthritis charities and drug companies, and said it was “a victory for commonsense”.

"NICE's decision will enable us to support both researchers and clinicians to move closer to what we regard as the medical equivalent of the Holy Grail - personalised medicine - with choice of treatment being more targeted and tailored towards individual needs,” added the charity's medical director Alan Silman.

"A major part of our research programme is to try and establish which patients will do best on which particular drug, and this decision will make that much more practically achievable," he noted.