1.1 Anakinra is recommended as an option for treating Still's disease with moderate to high disease activity, or continued disease activity after non-steroidal anti-inflammatory drugs (NSAIDs) or glucocorticoids. It is only recommended for:
adult-onset Still's disease that has responded inadequately to 2 or more conventional disease‑modifying antirheumatic drugs (DMARDs)
systemic juvenile idiopathic arthritis in people 8 months and older with a body weight of 10 kg or more that has not responded to at least 1 conventional DMARD.
1.2 This recommendation is not intended to affect treatment with anakinra 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 clinician consider it appropriate to stop. In the case of children and young people, this decision should be made jointly by the clinician, the child or young person, and their parents or carers.
Why the committee made these recommendations
Still's disease is a rare systemic autoinflammatory condition. People who are 16 years and under at diagnosis are considered to have systemic juvenile idiopathic arthritis, even in adulthood. People who are over 16 years at diagnosis are considered to have adult-onset Still's disease. Treatment options for Still's disease include NSAIDs, corticosteroids, non-biological DMARDs and biological DMARDs such as tocilizumab and anakinra.
Clinical evidence about the efficacy of anakinra after treatment with NSAIDs and corticosteroids is highly uncertain. But it is reasonable to assume that it is as effective as tocilizumab. Cost-effectiveness estimates for anakinra are also uncertain because of issues with the company's economic model and the lack of robust clinical evidence to support it. However, a comparison of the costs of anakinra and tocilizumab shows that they have similar weekly costs for:
adult-onset Still's disease that has responded inadequately to 2 or more conventional DMARDs
systemic juvenile idiopathic arthritis that has not responded to at least 1 conventional DMARD.
Anakinra is therefore recommended for use in the NHS in these circumstances.