The UK’s cost effectiveness body, the National Institute for Health and Clinical Excellence, has given its seal of approval for the use of Eli Lilly’s Alimta and Schering-Plough’s Remicade on the National Health Service.

Specifically, the Institute has issued final guidance for the use of Alimta (pemextred) to treat malignant pleural mesothelioma, a cancer associated with asbestos exposure and mostly affecting the lungs, in patients with a World Health Organisation performance status of 0 or 1, who are considered to have advanced disease, and who are unable to undergo surgery.

Mesothelioma is an aggressive tumour that is often not diagnosed until the advanced stages, at which point patients have an average life expectancy of five months. An estimated 1,700 people in the UK are diagnosed with the illness every year, a figure that is likely to peak at more than 2,000 cases by 2015.

Initially, the Institute turned down Alimta for MPM, but two subsequent appeals, during which a number of significant factors came to light – such as the easy identification of a subgroup of patients in whom the drug has greater effectiveness, and the availability of a smaller 100mg vial to cut costs - led to a u-turn on the original decision reached in 2006.

“I am confident that we have reached the right conclusion and as a result our guidance will lead to a uniform uptake of this important new treatment for the majority of people with MPM,” commented Dr Gillian Leng, Deputy Chief Executive and Executive Lead for the guidance.

However, Lilly suffered disappointment back in August when NICE published draft guidance turning away Alimta for patients with non-small cell lung cancer, claiming that there is no evidence the drug is more cost-effective than the older treatment docetaxel.

Remicade in for psoriasis
Meanwhile, the Institute published final guidance on the use of Remicade (infliximab) in patients with psoriasis, deeming it an effective use of NHS resources, shortly after giving the nod to the drug for rheumatoid arthritis last October.

Remicade, which works by blocking tumour necrosis factor, has only been recommended for use in patients who have severe forms of the disease, and have failed to respond or are intolerant to standard systemic therapies such as ciclosporin or methotrexate. Furthermore, NICE stipulates that treatment should only be continued in patients showing an adequate response after 10 weeks of therapy.

“We have recommended the use of infliximab for the treatment of adults with psoriasis who will benefit the most,” said Professor Peter Littlejohns, NICE Clinical and Public Health Director and Executive Lead for this guidance. “This is a good use of NHS resources and it will ensure that patients who suffer from this debilitating and distressing disorder can try an alternative treatment where other therapies have failed.”

There is limited data on the incidence of psoriasis in the UK, but estimates suggest that it affects around 2% of the population. A spokesperson for The Psoriasis Association told PharmaTimes: that the illness is "a long-term chronic condition and for many people it can have a profound social and psychological impact on their lives. We welcome the NICE approval of infliximab as it increases the treatment options available to those people who have severe psoriasis for whom previous treatments have been unsuccessful or inappropriate".