What has NICE said?
NICE does not recommend pegloticase for people who have severe, chronic gout with tophi who have either tried oral gout drugs (specifically xanthine oxidase inhibitors) and still have high uric acid levels, or cannot take oral gout drugs.
Why has NICE said this?
NICE looks at how well treatments work, and also at how well they work in relation to how much they cost the NHS. NICE did not recommend pegloticase because, although it worked well, it does not provide enough benefit to patients to justify its high cost. NICE also found that there was a risk of patients reacting badly to the infusion ('drip') and of anaphylaxis (a severe form of allergic reaction)with pegloticase treatment.
The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.