Sequential use of adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis
Status Discontinued
Decision Selected
Process MTA
Referral date 01 June 2004
Topic area
  • Musculoskeletal

The Technology Appraisal of adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis after failure of a previous TNF-α inhibitor ended following the publication of the appeal panel decision in November 2008.  The Institute decided that a new appraisal of the above TNF-α inhibitors should be scheduled into the work programme and combined with a review of technology appraisalguidance 126 (rituximab) and 141 (abatacept).

Provisional Schedule

Final scope published: November 2004
1st appraisal committee meeting: 03 April 2008
2nd appraisal committee meeting: 03 June 2008

Project Team

Assessment Group / Evidence Review Group: West Midlands Health Technology Assessment Collaboration
Communications manager: Tonya Gillis
Executive Lead: Andrew Dillon
Project manager: Jeremy Powell
Technical Lead: Zoe Garrett


Department of Health Eastern Hull PCT
  Somerset Coast PCT
  Welsh Assembly Government
Manufacturers / Sponsors Abbott Laboratories Ltd (adalimumab)
  Wyeth Pharmaceuticals (etanercept)
  Schering-Plough Ltd (infliximab)
Patient / Carer Groups Arthritis and Musculoskeletal Alliance
  Arthritis Care
  Arthritis Research Campaign
  Back Care
  Long Term Medical Conditions Alliance
  National Rheumatoid Arthritis Society
Professional Groups British Association of Spine Surgeons
  British Health Professionals in Rheumatology
  British Institute of Musculoskeletal Medicine
  British Orthopaedic Association
  British Society for Rheumatology
  Primary Care Rheumatology Society
  Royal College of Nursing
  Royal College of Physicians
Royal Pharmaceutical Society Others
Assessment Team West Midlands Health Technology Assessment Collaboration
  National Coordinating Centre for Health Technology Assessment
Associated Guideline Groups None
Associated Public Health Groups None
Comparator Manufacturers Roche
General Board of Community Health Councils in Wales
  Medicines and Healthcare products Regulatory Agency (MHRA)
  National Public Health Service for Wales
  NHS Quality Improvement Scotland
  British National Formulary
Research Groups None


Key events during the development of the guidance:

Date Update
19 October 2007 Following the appeal decision the Technology appraisal split. First use of TNF inhibitors published as TA130. As per appeal instruction sequential use of treatments to be discussed by the committee after additional analysis complete.
31 January 2008 Stakeholders invited to comment on the technical content of the additional analysis produced.
24 November 2008

The Appeal Panel met on 29 September 2008 to consider the appeals lodged against the Final Appraisal Determination (FAD) for this appraisal. The decision of the appeal panel can be found below.

The appeal was upheld under grounds 1 and 2 and the appeal panel has recommended that the appraisal of the sequential use of the three drugs after failure of the first TNF inhibitor should be restarted as a new appraisal. We have written to the Department of Health to ask whether they want us to do this and we will update this page of the web site when we have their response. As a consequence of the appeal panel's decision, this appraisal is now ended.

For further information on our processes and methods, please see our CHTE processes and methods manual