GPs air criticism of NICE RA advice

NICE has approved rituximab in combination with methotrexate for RA patients responding inadequately to anti-TNF therapy in draft guidance.

But it has rejected the routine use of the TNF inhibitors adalimumab, etanercept and infliximab after failure of another anti-TNF - such treatment should be limited to research studies, it said. NICE also rejected use of abatacept after failure of a TNF inhibitor.

Greater Manchester GP Dr Adam Bajkowski, a Primary Care Rheumatology Society member, said NICE needed to remember its role was to offer guidance.

'Informing one's colleagues that the current evidence would support first-line usage of rituximab over other biologicals after previous failures, is a far better way to communicate findings than simply stating rituximab is what you have to use, full stop.'

Dr Louise Warburton, a GPSI in rheumatology and musculoskeletal medicine in Shropshire, said: 'It is a shame NICE won't allow a second anti-TNF. The lack of evidence is a measure of the fact that the research has not yet been done, not a measure of ineffectiveness.'

The draft recommendations are open for consultation on the NICE website until 24 March.

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