1 Recommendations

1 Recommendations

1.1 Fostamatinib is not recommended, within its marketing authorisation, for treating refractory chronic immune thrombocytopenia in adults.

1.2 This recommendation is not intended to affect treatment with fostamatinib 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

Rituximab or mycophenolate are treatment options for refractory chronic immune thrombocytopenia after thrombopoietin receptor agonists, or if they are not suitable. Fostamatinib would be used at the same point in the treatment pathway.

Clinical evidence shows that fostamatinib is effective compared with placebo. There is no clinical trial evidence directly comparing fostamatinib with rituximab or mycophenolate. An indirect comparison shows that fostamatinib works better than rituximab at increasing platelet counts.

The cost-effectiveness estimates for fostamatinib compared with rituximab are higher than what NICE normally considers cost effective. So, fostamatinib is not recommended.

  • National Institute for Health and Care Excellence (NICE)