Navigation

Summary of guidance relevant to general practice in February 2012

Prolonged-release exenatide for type 2 diabetes

NICE has approved the use of exenatide in triple therapy regimens for patients with type 2 diabetes, in latest guidance.

Patients should be offered the drug if they are struggling to control their blood glucose levels or if they remain inadequate, defined as an HbA1c of 7.5 per cent or above, or other higher level as agreed with the individual.

Exenatide improves glycaemic control in a number of ways, such as by enhancing glucose-dependent insulin secretion to help lower the rise in blood sugar from eating.

The prolonged release suspension, which is recommended in the final guidance, is injected once weekly as opposed to twice a day for the conventional formulation.

Eligible patients should have a body mass index (BMI) of 35kg/m2 or higher in those of European family origin and specific psychological or medical problems associated with high body weight, or a BMI below 35 kg/m2 and therapy with insulin would have significant occupational implications or weight loss would benefit other significant obesity-related comorbidities.

Treatment with prolonged-release exenatide in a triple therapy regimen should only be continued if a beneficial metabolic response has been shown.

Exenatide can also be offered to some patients in dual therapy regimens, in combination with metformin or a sulphonylurea, but only if the patient is intolerant of either metformin or a sulphonylurea, or treatment with metformin or a sulphonylurea is contraindicated.

Patients must also be intolerant of thiazolidinediones and dipeptidyl peptidase-4 (DPP-4) inhibitors, or treatment with thiazolidinediones and DPP-4 inhibitors is contraindicated.

Support tools to help you put this guidance into practice

NICE has developed a clinical audit tool, an electronic audit tool and a costing statement to help put this guidance into practice.

Tocilizumab for rheumatoid arthritis

Patients with rheumatoid arthritis can now be offered tocilizumab alongside other treatment options at an earlier stage, says NICE.

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.

Support tools to help you put this guidance into practice

A commissioning guide on the use of biologic drugs for the treatment of inflammatory disease and a costing statement are available for this guidance.

22 February 2012

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.