| TA195 |
Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor (TA195) |
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Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
This guidance replaces NICE technology appraisal guidance 126 and 141 issued in August 2007 and April 2008 respectively. It also replaces the remaining recommendations in NICE technology appraisal guidance 36 issued in March 2002.
The appraisal of adalimumab and the review of the appraisals of etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis have resulted in changes in the guidance. Rituximab in combination with methotrexate is still recommended as an option for the treatment of adults with severe active rheumatoid arthritis who have had an inadequate response to, or have an intolerance of, other DMARDs, including at least one TNF inhibitor. Additional treatment options are now recommended for these adults if rituximab therapy is contraindicated or withdrawn because of an adverse event, specifically:
- If rituximab is contraindicated or withdrawn, adalimumab, etanercept, infliximab and abatacept, each in combination with methotrexate, are now recommended as treatment options.
- If rituximab therapy cannot be given because methotrexate is contraindicated or withdrawn because of an adverse event, adalimumab and etanercept, each as monotherapy, are now recommended as treatment options.
The price of abatacept has recently increased to £302.40 (excluding VAT) for a 250-mg vial. The manufacturer of abatacept has agreed a simple discount with the Department of Health as part of PPRS modulation with the result that the acquisition cost to the NHS remains the same as considered in the development of TA195 at £242.17 (excluding VAT) per 250-mg vial, until NICE next reviews the guidance on abatacept for this indication.
This change therefore does not affect the recommendations in TA195.
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Other information
How this guidance was produced
Background information
This page was last updated: 07 October 2011
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Guidance formats
- Web format
- Quick reference guide (PDF)
- Full Guidance (PDF)
- Patient version (MS Word)
- TA195 Adalimumab, etanercept, infliximab, rituximab ac abatacept i drin arthritis gwynegol: deall canllawiau NICE (fformat MS Word)
Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
Guideline for patients and carers (PDF)
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Implementation tools and resources
- Audit support
- Clinical audit tool
- Costing template
- Biologic drugs for the treatment of inflammatory disease in rheumatology, dermatology and gastroenterology commissioning guide
See this guidance in practice
Patient
The summary of the key recommendations in the guidance written for patients, carers and those with little medical knowledge and may be used in local patient information leaflets.
Quick Reference Guide
The quick reference guide presents recommendations for health professionals
NICE Guidance
The published NICE clinical guidance, contains the recommendations for health professionals and NHS bodies.
Full Guidance
The published full clinical guidance for specialists with background, evidence, recommendations and methods used.
