UK patients with mutiple myeloma are a step closer to getting secured first line access to Celgene’s Thalidomide and Janssen-Cilag’s Velcade on the NHS, as per draft recommendations by the National Institute for Health and Clinical Excellence.

The cost regulator’s draft guidance states that Celgene’s Thalidomide in combination with an alkylating agent and a corticosteroid can be used as a first-line treatment option for patients with the condition, but only when high-dose chemotherapy and stem cell transplantation are deemed inappropriate.

Treatment with Janssen-Cilag’s Velcade (bortezomib), plus an alkylating agent and corticosteroid, should only be considered if the patient is unable to tolerate or has contraindications for thalidomide.

Almost 4,000 patients are diagnosed with the blood cell cancer multiple myeloma in the UK every year. There is no cure for the disease, so current treatment strategies are focused on preventing disease progression and dealing with the symptoms of the illness.

According to Carol Longson, director of NICE’s Health Technology Evaluation Centre, the evidence “clearly showed that both thalidomide and bortezomib regimens are more effective at delaying disease progression and improving patients’ life expectancy than the current treatment of an alkylating agent and corticosteroid alone”.

But according to NICE’s Independent Appraisal Committee, clinical specialists it spoke to are of the belief that a thalidomide-based therapy would probably be considered more appropriate in most cases. Moreover, while clinical data indicates that both agents are on par with each other in terms of effectiveness, thalidomide regimens are cheaper than those with Velcade and so were considered to be more cost effective.

Janssen-Cilag said it is encouraged by the draft guidance from NICE, which, if accepted, “will mean that these patients will be able to access bortezomib as frontline treatment”.

The Institute recommended Velcade in October 2007 for patients who are experiencing their first relapse of the disease, under a ground-breaking risk-sharing scheme in which the NHS only funds treatment of patients showing a full or partial response to the drug, while the costs incurred for those not responding will be refunded by the drugmaker.