NICE backs only rituximab for use after TNF failure in RA

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approved rituximab, in combination with methotrexate, for RA patients responding inadequately to anti-TNF therapy in draft guidance.

NICE has issued a draft guidance open for consultation on the treatment of RA (Photograph: DR P. MARAZZI/SCIENCE PHOTO LIBRARY)
NICE has issued a draft guidance open for consultation on the treatment of RA (Photograph: DR P. MARAZZI/SCIENCE PHOTO LIBRARY)

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.

Dr Carole Longson, director of the health technology evaluation centre at NICE said that the available evidence suggested that rituximab works after failure of a TNF inhibitor and is a cost-effective treatment option.

‘There was limited evidence available to the appraisal committee on the clinical effectiveness of using a second TNF inhibitor (adalimumab, etanercept or infliximab) after a first one had failed,' she said. ‘The limited evidence did not suggest that any of the three drugs would be a cost-effective use of NHS resources when compared to rituximab.'

She added: ‘Abatacept appears to work no better than rituximab in this context, and it is more expensive, so the committee does not consider it to be good value for money.'

The draft recommendations are open for consultation until 24 March.

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