Abbott Laboratories’ Humira and Schering-Plough/Johnson & Johnson’s Remicade are now just a breath away from reimbursement on the National Health Service as treatments for Crohn’s disease.

The National Institute for Health and Clinical Excellence - which determines which therapies are routinely available on the NHS in England and Wales - has published a Final Appraisal Determination recommending the drugs, as treatment options for patients with severe active Crohn’s disease, but only when the disease has failed to respond to conventional therapy (such as immunosuppressive and/or corticosteroid treatments), or patients are unable to take them.

Remicade is also a cost-effective treatment option for patients with severe, active fistulising Crohn’s disease as well as for those aged six-17 years with severe, active forms of the illness, as long as they have failed to respond to/are intolerant to standard therapies, such as immunosuppressants and corticosteroids, NICE has ruled.

The cost watchdog has, however, stipulated that both Humira (adalimumab) and Remicade (infliximab) should be started by clinicians with experience of TNF inhibitors and of managing Crohn’s disease as a planned course of treatment, until therapy fails or for a total of 12 months following the start of the course, whichever turns out to be the shorter pathway, at which point patients must then be reassessed in order to gage whether continuation of therapy is still “clinically appropriate”.

Furthermore, it stresses that treatment should be started with whichever works out to be the less expensive therapy. While generally considered equals in terms of clinical effectiveness, there is a difference in base costs between the rivals: maintenance therapy with Remicade costs around £12,584, depending on the patient’s body weight, while induction treatment with Humira is around £1,073 and maintenance therapy £9,295 a year. However, costs may vary between patients because of different modes of administration and treatment schedules.

If there are no appeals to NICE’s proposals then its recommendations laid out in the FAD will become enshrined within the NHS, which is good news for the 60,000 patients or so thought to suffer with Crohn’s disease in the UK, particularly as both drugs have proven their ability to first induce remission in patients with active disease and then also prevent relapse in those who have responded to an induction regimen.