The National Institute for Health and Clinical Excellence (NICE) has opened a consultation on new draft guidance which provisionally recommends the use of Roche's RoActemra (tocilizumab) at additional stages of treating rheumatoid arthritis (RA).

In August 2010, NICE issued guidance TA198, which recommends RoActema as an option for people with RA if there has been an inadequate response to one or more tumour necrosis factor (TNF) inhibitors and where Roche's MabThera/Rituxan (rituximab) has also produced an inadequate response, or where it is contraindicated or has produced undesirable side effects.

The new document is a rapid review of TA198, following a new patient access scheme (PAS) which Roche has agreed with the Department of Health.

It states that, in specific circumstances, and only if the manufacturer provides RoActemra with the discount agreed as part of the PAS, the drug is provisionally recommended as an option for treating RA at an earlier point in the treatment pathway. This is where the disease has responded inadequately to disease-modifying anti-rheumatic drugs (DMARDs) and RoActemra is used as described for other TNF inhibitor treatments – Abbott Laboratories’ Humira (adalimumab), Amgen/Pfizer’s Enbrel (etanercept) and Centocor’s Remicade (infliximab) - in NICE guidance TA130.

The draft also includes using RoActemra as originally recommended in TA198 for people whose disease responded inadequately after both rituximab and TNF inhibitors were tried, and a recommendation on using RoActemra when rituximab cannot be used after TNF inhibitor treatment has failed.

In all cases, this is on the basis that the manufacturer provides RoActemra with the discount agreed as part of the PAS.

Professor Carole Longson, director of the Health Technology Evaluation centre at NICE, pointed out that the Institute has already recommended a range of treatments to help patients manage RA, and she said that it welcomes comments on its new draft recommendations.

The closing date for comments is October 28, and the second Appraisal Committee meeting will be held November 8.