As expected patients with rheumatoid arthritis (RA) are to get access to Merck Sharpe and Dohme's Simponi on the National Health Service, after cost regulators issued the final stamp of endorsement for the drug, in certain circumstances.

The National Institute for Health and Clinical Excellence has published final guidance recommending the use of Simponi (golimumab) on the NHS in England and Wales, but only when other treatments have failed.

More specifically, the Institute's guidance stipulates that Simponi, in combination with methotrexate, should be considered for adults whose disease has not responded to both conventional and other disease-modifying antirheumatic drugs (DMARDs), when used as per the other tumour necrosis factor inhibitor treatments already available on the NHS – Amgen/Pfizer's Enbrel (etanercept), Johnson & Johnson/Merck's Remicade (infliximab) and Abbott Laboratories Humira (adalimumab).

In all circumstances, NICE has clearly stated that the drug is only being backed for funding on the proviso that MSD provides the 100mg dose of Simponi at the same price as the 50mg version, to ensure it remains cost-effective.

Simponi is a human monoclonal antibody prevents TNF from binding to its receptors and thereby neutralises its activity, and is the first once-monthly, self-administered, subcutaneous anti-TNF to be licensed for the management of RA, psoriatic arthritis and ankylosing spondylitis.

At £9,155 per patient per year therapy with the drug doesn't come cheap, but as the annual cost of RA due to sick leave and work related disability is estimated to be around £1.8 billion, managing the disease is crucial not only for patients' wellbeing but also for the economy.

MabThera for maintenance

Meanwhile, the Institute has also published final guidance recommending the use of Roche's MabThera (rituximab) as a maintenance therapy for non-Hodgkin’s lymphoma.

The guidance states that the drug can be used as a first-line maintenance treatment in people with follicular non-Hodgkin’s lymphoma that has responded to first-line induction therapy with MabThera in combination with chemotherapy, in order to help prevent the spread of the disease.

According to Professor Peter Littlejohns, NICE's clinical and public health director, MabThera has the potential to improve the lives of hundreds of patients.

"Current NHS practice is for doctors to wait until the cancer begins to grow again before giving patients more treatment, [but] the evidence demonstrates that this drug works well as a maintenance treatment for patients, and offers value for money for the NHS,” he said, explaining the decision.