Patients with multiple myeloma are being barred from routine access on the NHS to Celgene's Revlimid and Amgen's Kyprolis in the second-line setting.

The National Institute for Health and Care Excellence has published new draft guidelines turning down the drug's use in patients who have had one prior treatment with Janssen's Velcade (bortezomib).

Compared with other treatments, such as melphalan (a cytotoxic chemotherapy), the committee concluded that use of Revlimid (lenalidomide) earlier in the treatment pathway would not be cost effective for the NHS.

The company has offered a complex patient access scheme under which the cost of the drug for people remaining on treatment for more than 26 cycles would have been met by the company.

However, NICE's committee concluded that even including this patient access scheme the most plausible incremental cost effectiveness ration lay above either £46,000 or £48,000 per QALY gained, and thus substantially above what is normally considered value for money.

Revlimid, which is currently funded on the NHS as a third-line treatment, also failed to meet criteria for inclusion in the Cancer Drugs Fund and end-of-life considerations in the second-line setting, it said.

Kyprolis rejected

Second-line use of Amgen's Kyprolis (carfilzomib) in combination with Revlimid and dexamethasone or dexamethasone alone was also rejected by NICE in an appraisal consultation document.

Based on uncertainties in clinical and cost-effectiveness results and that the drug failed to meet the 24-month extension criterion for end-of-life, the committee concluded that it could not recommend Kyprolis as a cost-effective use of NHS resources.

It could not agree on the best cost-effectiveness estimate, "because both the company's and the ERG's approach to modelling were highly uncertain".