Evidence-based recommendations on ibrutinib (Imbruvica) for treating chronic lymphocytic leukaemia in adults.
NICE is aware that questions have been raised about the interpretation of its guidance on the use of ibrutinib for previously treated chronic lymphocytic leukaemia (TA429). The marketing authorisation for ibrutinib in this indication is not comprehensive in its description of the eligible patient population and neither is our guidance.
Given the evidence that was considered by the NICE appraisal committee, we consider it reasonable for the guidance to be read as referring to those patients considered unsuitable for retreatment. Because unsuitability for retreatment is not defined in the guidance, we consider it appropriate for NHS England, as the commissioner, to take clinical advice in order to do so.
Guidance development process
Next review: January 2020
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.