Draft NICE guidance recommends first biologics for treatment of moderate rheumatoid arthritis

Final draft guidance from the National Institute for Health and Care Excellence states that adalimumab, etanercept and infliximab are recommended in the treatment of moderate rheumatoid arthritis.

For the first time, biologics have been recommended for the treatment of moderate rheumatoid arthritis (RA) in final draft guidance from the National Institute for Health and Care Excellence (NICE).

The guidance, which was published on 10 June 2021, says that adalimumab, etanercept and infliximab, all taken with methotrexate, are recommended for use within the NHS. In addition, adalimumab and etanercept can be used as monotherapy when methotrexate is contraindicated or not tolerated.

The treatments have been recommended only if intensive therapy with two or more conventional disease-modifying antirheumatic drugs have not controlled the disease.

Previously, NICE only recommended biological treatments for severe RA; however, with the increasing availability of biosimilars — medicines that are developed to be similar to an existing biological medicine — the guidance was reviewed.

The NICE committee found that clinical trial evidence suggested that the treatments provided similar benefits for people with moderate disease to those with severe disease.

“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,” said Meindert Boysen, deputy chief executive and director of the Centre for Health Technology Evaluation at NICE.

“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.”

Andrew Pothecary, rheumatology and biologics lead pharmacist at the Royal Cornwall Hospital and expert advisor to the National Rheumatoid Arthritis Society, described the recommendations as a “major change” in the treatment of patients with moderate RA.

“[It] will enable thousands of people to access a wider range of effective medications for their condition. For individual patients, it means they will be able to get back to a more normal life, continuing with activities, hobbies, and sports they enjoy, as well as being able to continue or stay in work,” he said.

“Anti-TNFs [tumour necrosis factor inhibitors] may not be a suitable treatment for all patients with moderate RA, and they will need to discuss their individual risks and benefits with their rheumatology team,” he added.

“Given the current pressures on the NHS, it will take time to implement these changes, but I’m optimistic that many patients will start to see the benefits of these treatments over the next six to twelve months.”

According to NICE, rheumatoid arthritis affects around 400,000 people in the UK, and more than 150,000 have moderate rheumatoid arthritis specifically. The new recommendations will benefit more than 15% of people with moderate rheumatoid arthritis that have not responded to conventional therapies.

Last updated
The Pharmaceutical Journal, PJ, June 2021, Vol 306, No 7950;306(7950)::DOI:10.1211/PJ.2021.1.90503

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