The National Institute for Health and Clinical Excellence (NICE) has issued final guidance recommending Roche's MabThera (rituximab) as an option when used in combination with a wide range of chemotherapy treatments for advanced follicular lymphoma. 

Evidence shows that adding MabThera to cyclophosphamide, vincristine and prednisolone (CVP), cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP), mitoxantrone, chlorambucil and prednisolone (MCP) and cyclophosphamide, doxorubicin, etoposide, prednisolone and interferon-a (CHVPi ) helps people to live longer and improves their quality of life compared with chemotherapy alone, and it is also good value for money for the NHS, says NICE.

In addition, the Institute's independent appraisal committee considered the use of MabThera plus chlorambucil for advanced follicular lymphoma, and concluded that this is an appropriate use of NHS resources.

Around 1,850 people in England and Wales have follicular lymphoma, and the majority of people present with advanced-stage disease (III-IV). Advanced disease is not curable, so the aim of disease management is to both increase life expectancy and health-related quality of life.

The committee had heard from patient experts that rituximab treatment improves their quality of life, said NICE's deputy chief executive, Dr Gillian Leng, adding: "we also know a range of choice and availability of treatments has a positive effect on patients and their families."

"At the second committee meeting, members heard from the clinical specialist that some older people are not fit enough to receive the most common types of chemotherapy. For that reason, the committee decided to also recommend rituximab in combination with chlorambucil in the final guidance, to give clinicians wider treatment options for their patients," said Dr Leng.

- NICE has also issued final guidance recommending the use of Bristol-Myers Squibb/Pfizer's Eliquis (apixaban) as an option for the prevention of venous thromboembolism (VTE) in adults who have undergone planned total hip replacement or total knee replacement surgery.

"VTE is often difficult to spot because patients may not always have symptoms to give a warning. Even if a blood clot does not come loose, it can still cause long-term damage to the veins  - for example, 'post-thrombotic syndrome' may develop up to two years following DVT, causing chronic swelling and ulceration of the legs," said Professor Carole Longson, director of NICE's health technology evaluation centre.

"Apixaban has been shown to be a clinically and cost-effective option for preventing blood clots following elective hip and knee replacement surgery," she said.