NICE recommend several treatment options for moderate arthritis

NICE have published final draft guidance, recommending several treatment options for around 25,000 people with moderate rheumatoid arthritis, who were unresponsive to conventional therapies.

The treatments recommended for use in the NHS are adalimumab, etanercept, and infliximab, taken with methotrexate. These treatments can also be used for monotherapy when methotrexate is too risky or not tolerated.

Previous NICE guidance only suggested treatments for severe rheumatoid arthritis. The change comes as other biosimilars have become available, making these treatments available at a lower price in the NHS.

The clinical trials showed that this treatment produced similar benefits for those with moderate rheumatoid arthritis compared to those with a severe version. Adalimumab, etanercept, and infliximab - after 2 or more conventional disease-modifying antirheumatic’s (DMARDs) - are now recommended as being cost-effective for use in the NHS for treating moderate rheumatoid arthritis.

Meindert Boysen, Deputy Chief executive and Director of the Centre for Health Technology Evaluation at NICE said: “I am delighted that we are able to recommend additional treatment options for people with moderate rheumatoid arthritis whose disease hasn’t responded to conventional treatments.

“These recommendations come after a pragmatic review of existing guidance in response to the availability of biosimilars in the NHS. We are pleased that the introduction of biosimilars has lowered overall costs of treatment, allowing our independent committee to recommend biological treatment for more people with rheumatoid arthritis so they can enjoy a better quality of life.”

The guidance only recommends the use of these treatments if intensive therapy with two or more conventional DMARDS, have not controlled the disease. To continue to control costs, and taking into consideration administration costs, dose needed, and product price per dose – treatments should be provided at the same or lower price, than agreed with the Commercial Medicines Unit. The guidance also states that if more than one treatment is suitable, treatment should be started with the least expensive drug.

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