The National Institute for Health and Clinical Excellence is leaning towards recommending Roche’s MabThera as a National Health Service funded maintenance option for patients with follicular non-Hodgkin’s lymphoma (NHL).

The cost regulator has published preliminary draft guidance endorsing MabThera (rituximab, also sold as Rituxan) as a first-line maintenance treatment for certain patients with the disease, based on evidence that the drug “could significantly help to delay the growth and spread of the cancer”.

Maintenance therapy is used to prevent cancer recurrence following initial treatment with chemotherapy, and as this has not been available for NHL to date, MabThera could offer NHS patients new hope for delaying further progression of the disease and the need for subsequent chemotherapy. This should mean that patients have “fewer chemotherapy-associated side effects long-term and so improve their quality of life,” noted Peter Littlejohns, Clinical and Public Health Director at NICE.

However, the Institute was a little tentative in reaching its decision, because evidence submitted by the manufacturer “did include some uncertainties, mostly around the extent to which [the drug] can extend a patient’s life expectancy and the impact of this assumption on its cost-effectiveness,” Littlejohns explained.

The appraisal committee did feel that MabThera is likely to be an cost-effective use of NHS resources, but has requested that Roche provides additional information to confirm the drug’s benefits in time for independent analysis before the second appraisal meeting takes place in February next year.

Specifically, it has asked for a revised cost-effectiveness analysis: for people who are 60 to 65 years at the start of treatment and in which: duration of clinical benefit from maintenance treatment is three to four years; the extent that progression-free survival translates into overall survival gain is informed by the best available evidence; and utility gains associated with delaying the need for chemotherapy after relapse are included.

Biologics commissioning guidelines

Meanwhile, the Institute has published new guidelines designed to improve commissioning of biologic drugs to treat inflammatory diseases and thereby help the NHS make better use of its resources.

Over the last decade the use of biologic drugs to treat inflammatory diseases has really taken off, but these therapies tend to be much more expensive than their conventional rivals, and their inappropriate use can weigh heavily on NHS resources.

NICE’s new guidelines have been compiled to highlight the potential benefits of effectively commissioning biologic drugs, including the avoidance of unnecessary costs and improving patient outcomes, when used accordingly, and should be used as a tool to improve patient care, the Institute noted.

“The effective commissioning of these drugs has the potential to contribute to the efficiency savings within the care pathway – for example, earlier initiation and better long-term care of patients may help to prevent or reduce costly exacerbations of the disease, hospital admissions and surgical interventions,” stressed GP Carl Parker, joint professional executive committee chair for Hartlepool PCT and North Tees PCT.

Commissioning biologic drugs for the treatment of inflammatory disease in rheumatology, dermatology and gastroenterology is the first of NICE’s commissioning guides to be based on recommendations it has made for the use drugs within its technology appraisals programme.