Cost regulators for the NHS in England and Wales have issued final guidelines recommending seven biological disease modifying drugs for severe rheumatoid arthritis which has not responded to conventional disease modifying therapy.

The guidance recommends: AbbVie’s Humira (adalimumab); Pfizer’s Enbrel (etanercept); Merck Sharp & Dohme’s (MSD) Remicade (infliximab) and biosimilars by Hospira UK (Inflectra) and Napp Pharmaceuticals (Remsima); UCB Pharma’s Cimzia (certolizumab);  MSD’s Simponi (golimumab); Roche’s RoActemra (tocilizumab); and Bristol-Myers Squibb’s Orencia (abatacept), each in combination with methotrexate. 

Humira, Enbrel, Cimzia or RoActemra are also recommended as monotherapy for people who cannot take methotrexate, the Institute said.

Publication of the guidance follows unsuccessful appeals against the draft guidance, including from the National Rheumatoid Arthritis Society, which argued that it should also include patients with moderate active forms of the disease, and MSD, which claims that it is skewed in favour of Remicade’s biosimilars given that the Institute advises starting treatment with the least expensive drug. 

“This guidance considers at what stage it’s clinically and cost effective to start using biological therapies as treatment options for adults with rheumatoid arthritis,” said Carole Longson, director of the Health Technology Evaluation Centre at NICE.

“In recommending them as options for people with severe rheumatoid arthritis after previous treatment with conventional DMARDs has been unsuccessful, this guidance reaffirms our previous recommendations on these drugs and confirms their place as an integral part of the rheumatoid arthritis treatment pathway.” 

Rheumatoid arthritis is an incurable chronic systemic inflammatory autoimmune disease affecting around 400,000 people in the UK, of whom around 15% have severe disease.