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    Has all of the relevant evidence been taken into account?

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    Are the summaries of clinical and cost effectiveness reasonable interpretations of the evidence?

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    Are the recommendations sound and a suitable basis for guidance to the NHS?

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Draft guidance consultation

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1 Recommendations

1.1

Efgartigimod should not be used to treat progressive or relapsing active chronic inflammatory demyelinating polyneuropathy (CIDP) in adults after corticosteroids or immunoglobulins.

1.2

This recommendation is not intended to affect treatment with efgartigimod that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS healthcare professional consider it appropriate to stop.

What this means in practice

These are NICE's draft recommendations. If these recommendations become final, efgartigimod would not be required to be funded and should not be used routinely in the NHS in England for the condition and population in the recommendations.

This is because there is not enough evidence to determine whether efgartigimod is value for money in this population.

Why the committee made these recommendations

Usual maintenance treatment for CIDP is immunoglobulins, after treatment is started with either corticosteroids or another immunoglobulin.

Clinical trial evidence suggests that efgartigimod reduces the risk of relapse compared with placebo. But it is uncertain how well efgartigimod may work in clinical practice because the trial population does not reflect the population that would have efgartigimod in the NHS. Indirect treatment comparisons with immunoglobulins are highly uncertain but suggest that efgartigimod might work as well as these.

There are uncertainties in the economic model, including:

  • the assumptions on:

    • how immunoglobulins are used in NHS clinical practice

    • how often people would take efgartigimod

  • a key assumption that efgartigimod works as well as immunoglobulins is not included.

Because of the uncertainties in the economic model, it is not possible to determine the most likely cost-effectiveness estimates for efgartigimod. So, efgartigimod should not be used.