The Scottish Medicines Consortium has approved the use of Eli Lilly’s Alimta for lung cancer and Janssen-Cilag’s Stelara for psoriasis on the National Health Service.

The cost regulator for NHS Scotland announced yesterday that it considers the combination of Alimta (pemexetred) and cisplatin a cost-effective use of resources when used as a first-line treatment for patients with locally advanced or metastatic non-small cell lung cancer (NSCLC), but only in those with the adenocarcinoma or large cell carcinoma type.

Alimta has been in use as a second-line therapy for NSCLC for some time, and welcoming the SMC’s decision, Dr Marianne Nicolson, Consultant Medical Oncologist at the Aberdeen Royal Infirmary, said it will enable oncologists “to use a familiar therapy earlier in the treatment pathway, allowing prolongation of patients’ lives while minimising the side-effects of chemotherapy”.

Lung cancer is Scotland’s biggest cancer killer accounting for over 4,000 deaths each year. The prognosis for patients with NSCLC is poor with an expected survival of around six months from diagnosis, and just 20% are still alive after a year.

In clinical trials, overall survival was improved significantly with Alimta/cisplatin in patients with large cell carcinoma histology compared to the gold standard treatment of gemcitabine and cisplatin (10.4 months versus 6.7 months respectively), and the combination was also better tolerated, an important factor in treatment.

Commenting on the SMC approval, Professor Keith Kerr, Consultant Pathologist at the Aberdeen Royal Infirmary said it is good news for lung cancer patients in Scotland, and added that the therapy represents “a level of innovation which allows clinicians to target the right patients with the right treatment based on sound histological diagnosis”.

Stelara also in
Meanwhile, the cost watchdog also issued its stamp of approval for Janssen-Cilag’s first-in-class biologic Stelara (ustekinumab) as a treatment for moderate-to-severe plaque psoriasis.

The SMC agreed that the drug is indeed a cost-effective use of NHS resources, but only as part of a patient access scheme under which the company provides the 90mg dose necessary for patients weighing more than 100kg at the same total cost as for a single 45mg vial, to help keep treatment costs at around £9,335 a year and cap the financial burden.

According to Janssen-Cilag, Stelara provides “visible and significant improvements in psoriasis severity” and also has the “added advantage of a convenient dosing regimen”, which is comprised of a ‘mere’ five injections a year compared to a possible 104 with Wyeth’s popular rival Enbrel (etanercept).

Janice Johnson, Co-Founder and Trustee of the Psoriasis Scotland Arthritis Link Volunteers (PSALV), has welcomed the SMC’s decision. “Around 125,000 people in Scotland suffer from psoriasis [and] some patients who have received Stelara have seen real benefits,” she said.

And David Burden, consultant dermatologist at the Western Infirmary in Glasgow, said the move “provides both physicians and patients with a new treatment option, which is important because psoriasis can be a challenging disease to treat,” and he highlighted the benefits of three monthly injections compared to once a week regimen necessary for some alternative therapies.

Both Alimta and Stelara have been approved for these uses by the cost watchdog for England and Wales, the National Institute for Health and Clinical Excellence.