Scottish cost regulators have approved the use of Bristol Myers-Squibb's subcutaneous version of Orencia (abatacept) on the National Health Service as a first-line biologic agent for adults with rheumatoid arthritis.

The drug, which is given in combination with methotraxate, should only be prescribed if treatment with conventional disease modifying anti-rheumatic drugs (DMARDs) has not been successful.

Additionally, Orencia's use has been restricted in Scotland to patients with active rheumatoid arthritis as measured by disease activity score greater than 5.1 confirmed on at least two occasions, one month apart.

Endorsement by the Scottish Medicines Consortium, which comes on the back of a Patient Access Scheme to improve its cost-effectiveness, means that Orencia is now the only biologic available in NHS Scotland in both self-injectable subcutaneous and intravenous formulations.

Experts have hailed the move.

"The convenience of self-administration in a subcutaneous formulation not only benefits patients but also improves cost effectiveness for the NHS,” said Professor Iain McInnes, Director, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow.

"There are many patients who would prefer the convenience of being able to self-inject at home rather than have to take time off work, or have to travel to the hospital for an infusion which, given the pain and mobility issues caused by RA, can be challenging,” added Ailsa Bosworth, Chief Executive and Founder of the National Rheumatoid Arthritis Society.

Other SMC approvals include: Gilead's four-in-one HIV pill Stribild, for use in adults who are antiretroviral treatment-naïve or infected with HIV-1 without known mutations linked with resistance to the antiretroviral agents in the product; Intermune's Esbriet (pirfenidone), for use in adults for the treatment of mild to moderate idiopathic pulmonary fibrosis, in those with a predicted forced vital capacity less than or equal to 80%; and Mitsubishi Pharma's Exembol (argatroban), for anticoagulation in adult patients with heparin-induced thrombocytopenia type II who require parenteral anti-thrombotic therapy.