Charities criticise NICE rheumatoid arthritis ruling

Rheumatoid arthritis (RA) patients who fail to respond to one tumour-necrosis factor (TNF) inhibitor should not be offered treatment with a different anti-TNF, NICE has ruled.

The final appraisal determination on the sequential use of adalimumab, etanercept and infliximab has been criticised by arthritis charities, with the National Rheumatoid Arthritis Society (NRAS) saying it puts ‘another nail in the coffin for the treatment of RA in England and Wales’.

In September, NICE ruled that an anti-TNF drug could be used once two other disease-modifying antirheumatic drugs had been tried and failed to work. Even then, only patients who showed a 1.2 point improvement in disease activity score (DAS28) over six months could remain on the treatment.

However, that guidance did say that those who suffered an adverse effect on one anti-TNF drug should be offered a second anti-TNF.

But the latest move, coupled with NICE’s earlier decision not to approve abatercept for RA, means that the drug options for RA patients has effectively dropped from five to two, says the NRAS.

Chief executive Ailsa Bosworth said: ‘NICE is systematically taking away clinically effective and proven treatments from patients and giving them just one roll of the dice when it comes to anti-TNF treatment.’

NICE final appraisal determination on the sequential use of adalimumab, etanercept and infliximab

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