Scottish cost regulators have endorsed National Health Service use of seven new medicines including treatments for ovarian cancer, hepatitis C and blood cancer.

First up, patients with ovarian cancer will now be able to get routine access to Roche’s Avastin (bevacizumab), but only in combination with paclitaxel. However, SMC backing, which follows a rejection earlier this year, is contingent upon continued availability of a Patient Access Scheme that improves the drug’s cost-effectiveness.

Novartis’ Signifor (pasireotide) received a green light for the treatment of adult patients with acromegaly - a rare condition usually caused by a non-cancerous tumour on the pituitary gland - for whom surgery is not an option or has failed and who are inadequately controlled on treatment with another somatostatin analogue.

Janssen-Cilag’s Velcade (bortezomib) can be used to treat the rare and aggressive blood cancer mantle cell lymphoma alongside rituximab, cyclophosphamide, doxorubicin and prednisone, in untreated adults who cannot have blood stem-cell transplantation. According to the SMC, the drug offers patients who currently have limited treatment options a potential improvement in both life expectancy and quality of life.

Gilead’s Harvoni (ledipasvir-sofosbuvir) has been accepted for use to treat genotype 3 forms of chronic hepatitis C. There are currently very few treatment options for this subset of patients, and ledipasvir-sofosbuvir may offer the prospect of cure, the SMC said. The drug is now routinely available in Scotland to treat genotypes 1 and 4 of the disease.

Bayer’s Eylea (aflibercept) is in as a treatment for impaired vision caused by macular oedema that follows blockage of either the main vein carrying blood from the retina (central retinal vein occlusion, CRVO) or of smaller branch veins (branch retinal vein occlusion, BRVO), expanding the options for improving vision for patients who don’t respond or cannot take currently available therapies. Its acceptance is also dependent on a PAS to secure value for money.

Patients with type II diabetes who are not maintaining their blood level targets on insulin alone can now also access Merck Sharp and Dohme’s Januvia (sitagliptin) via NHS Scotland to improve control of their disease. The SMC has previously accepted the drug for use in combination with a sulfonylurea and for restricted use with metformin and as monotherapy. 

Shire’s Elvanse Adult (lisdexamfetamine) was endorsed as part of a programme of treatment for adults with attention deficit hyperactivity disorder that is at least moderately severe. As the medicine is taken as a once daily tablet, it can make it easier for patients and their carers to manage and monitor treatment, the cost watchdog noted.

Vimizim, Spedra ousted

On the downside, BioMarin’s Vimizim (elosulfase alfa) was rejected for Morquio A syndrome (also known as mucopolysaccharidosis type IVA), despite a “powerful testimony” from patients about the impact of this rare inherited disease. “While elosulfase alfa has the potential to improve quality of life in the short term, the case presented by the company was not robust enough to convince the Committee about the longer-term benefits when balanced against its extremely high cost,” the SMC explained.

Also not recommended was A Menarini’s Spedra (avanafil), another treatment option for men with erectile dysfunction, as the company failed to present a sufficiently robust clinical and economic analysis.