1 Recommendations

1 Recommendations

1.1 Interferon beta‑1a is recommended as an option for treating multiple sclerosis, only if:

  • the person has relapsing–remitting multiple sclerosis and

  • the companies provide it according to commercial arrangements.

1.2 Interferon beta‑1b (Extavia) is recommended as an option for treating multiple sclerosis, only if:

  • the person has relapsing–remitting multiple sclerosis and has had 2 or more relapses within the last 2 years or

  • the person has secondary progressive multiple sclerosis with continuing relapses and

  • the company provides it according to the commercial arrangement.

1.3 Glatiramer acetate is recommended as an option for treating multiple sclerosis, only if:

  • the person has relapsing–remitting multiple sclerosis and

  • the company provides it according to the commercial arrangement.

1.4 Interferon beta‑1b (Betaferon) is not recommended within its marketing authorisation as an option for treating multiple sclerosis.

1.5 These recommendations are not intended to affect treatment with a beta interferon or glatiramer acetate that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. For children and young people, this decision should be made jointly by them, their clinician, and their parents or carers.

Why the committee made these recommendations

Evidence from clinical trials and the Department of Health's Risk Sharing Scheme shows that glatiramer acetate and the beta interferons are effective for treating multiple sclerosis. It also shows that all the treatments work similarly in slowing progression of disability and in reducing the number of multiple sclerosis-related relapses.

The cost-effectiveness estimates for both interferon beta‑1b (Extavia) and glatiramer acetate compared with best supportive care are within the range that NICE usually considers a cost-effective use of NHS resources. Extavia needs mixing before it is injected and some people with multiple sclerosis might find this difficult. Taking this into consideration, interferon beta‑1a is also considered an appropriate use of NHS resources even though the range of cost-effectiveness estimates are above what NICE usually considers acceptable. Therefore, interferon beta‑1a, interferon beta‑1b (Extavia) and glatiramer acetate are recommended as options for treating multiple sclerosis in the NHS.

The most likely cost-effectiveness estimate for interferon beta‑1b (Betaferon) is higher than what NICE considers acceptable and it also has to be mixed before use. Therefore, Betaferon is not recommended for multiple sclerosis because it would not be a good use of NHS resources.

The committee is unable to make recommendations specifically for treating clinically isolated syndrome because the diagnostic criteria for multiple sclerosis and clinically isolated syndrome changed in 2010, and the evidence comes from clinical trials done before 2010 so is no longer generalisable to current UK clinical practice.

  • National Institute for Health and Care Excellence (NICE)