Green light for earlier use of rheumatoid arthritis drug
Patients with rheumatoid arthritis can now be offered tocilizumab alongside other treatment options at an earlier stage, says NICE.
Rheumatoid arthritis is a chronic, progressive and disabling auto-immune disease affecting 580,000 people in England.
Tocilizumab is a monoclonal antibody that works by reducing levels of inflammation in the joints, preventing long-term damage, and improving the quality of life and function for patients with the disease.
Under this updated guidance, tocilizumab is now recommended, in combination with methotrexate, for treating rheumatoid arthritis if treatment with disease-modifying anti-rheumatic drugs (DMARDS) has failed, and provided that the manufacturer offers the drug with the discount agreed as part of the patient access scheme.
NICE carried out a rapid review of the existing guidance, which was published in August 2010, following the submission of a patient access scheme which the manufacturer Roche has agreed with the Department of Health.
Patient access schemes are special ways pharmaceutical companies can propose to enable patients to gain access to high costs drugs.
The original guidance recommended that tocilizumab be offered as an option for people with rheumatoid arthritis if there has been an inadequate response to one or more TNF inhibitors, and where rituximab has also produced an inadequate response or where rituximab is contraindicated or has produced undesirable side effects.
The updated guidance still includes these recommendations, and in all cases this is on the basis that the manufacturer provides tocilizumab with the discount agreed as part of the patient access scheme.
Professor Carole Longson, Director of the Health Technology Evaluation Centre at NICE, said: “Rheumatoid arthritis can have a huge impact on quality of life and for many it's a disabling condition, so we're pleased to recommend tocilizumab at an additional stage in treating the condition.
“Today's new guidance recommends tocilizumab alongside other treatment options earlier in the treatment pathway: after treatment with conventional drugs - DMARDS - has failed.
“We have already recommended the TNF inhibitors adalimumab, etanercept, infliximab, certolizumab pegol and golimumab for some people with rheumatoid arthritis as options for use at this stage; tocilizumab is now added as another option alongside these treatments.
“If TNF inhibitor treatments have failed and patients are unable to take rituximab or rituximab has also failed, the guidance also recommends that tocilizumab could be a treatment option at this point.”
This guidance complements the range of treatments that NICE has previously recommended for different stages of rheumatoid arthritis to help patients manage this difficult condition, added Dr Longson.
22 February 2012