The group of patients with rheumatoid arthritis (RA) able to get routine access to Bristol-Myers Squibb's Orencia on the National Health Service has been widened, following the publication of new guidance by the National Institute for Health and Care Excellence.

The cost regulator has agreed that Orencia (abatacept) is a cost-effective option when used alongside methotrexate to treat RA patients, but only if the disease has failed to respond to two conventional non-biological disease-modifying anti-rheumatic drugs (DMARDs), including methotrexate itself.

In addition, the Institute has also stipulated that the drug must be used in line with the recommendations for other biological DMARDs, as described in its Technology Appraisal Guidance 130.

Currently, around 400,000 people suffer from RA in the UK, and according to Carole Longson, Director of the Health Technology Evaluation Centre at NICE, the new guidance "will widen the choice of treatments available at this stage of the treatment pathway". 

Back in 2011, NICE rejected the Orencia's use on the NHS in this setting on grounds that it did not offer value for money compared to alternatives such as AbbVie's Humira (adalimumab), but a subsequent patient access scheme triggered a rapid review of the decision and helped sway its position.

The Institute has also already endorsed Orencia (and other drugs) as an option for patients who have not responded adequately to therapy with one or more TNF inhibitors, or those who cannot receive Roche's MabThera/Rituxan (rituximab) because it is contraindicated or withdrawn because of an adverse event.