they have had only 1 previous therapy, which included bortezomib, and
the company provides carfilzomib according to the commercial arrangement.
1.2 This recommendation is not intended to affect treatment with carfilzomib plus lenalidomide and dexamethasone 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.
Why the committee made these recommendations
Clinical trial evidence shows that carfilzomib plus lenalidomide and dexamethasone gives longer periods of remission and people live longer, compared with lenalidomide plus dexamethasone. This treatment benefit appears to continue for up to 6 years. However, there is uncertainty about how long the benefit lasts after this.
The most likely cost-effectiveness estimates are within what NICE normally considers a cost-effective use of NHS resources. So, carfilzomib plus lenalidomide and dexamethasone is recommended.