EMAIL I RECEIVED FROM NICE-NO MORE MEDS | Arthritis Information

Thank you for contacting the National Institute for Health and Clinical Excellence (NICE). NICE is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health.

As part of our role our organisation is asked to produce guidance on the use of medicines and make recommendations on the treatment’s clinical effectiveness (that is, how well it works) and cost effectiveness (how well it works in relation to how much it costs). NICE has been asked by the Department of Health to develop guidance for the NHS on the sequential use of adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis. This guidance has not yet been issued, but the committee has produced a final draft, which we have posted on our website.

When preparing this consultation document, the Committee took into account:

• an independent review of the published literature

• submissions including trial data from manufacturers

• written and oral submissions from the national groups representing health professionals who are familiar with the treatment

• written and oral submissions from the national groups representing people who have had the treatment

After looking at all of the available evidence the committee decided that our draft recommendation for this appraisal should be that adalimumab, etanercept and infliximab are not recommended for the treatment of rheumatoid arthritis due to the failure of a previous tumour necrosis factor alpha (TNF-α) inhibitor. The only exception to this would be if the drugs were provided in the context of research. Such research should be designed to evaluate the clinical effectiveness of these drugs when used sequentially after the failure of a previous TNF-α inhibitor, in comparison with management strategies that do not include the use of TNF-α inhibitors.

People already receiving adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis after the failure of a previous TNF-α inhibitor should have the option to continue therapy until they and their clinician consider it appropriate to stop.

Registered stakeholder organisations had until 1st August to contact us if they wished to appeal against this guidance. Patient and carer groups whose members were likely to be affected by our guidance also had the opportunity to submit evidence and comment on the preliminary recommendations. If we receive appeals, we will arrange an appeal hearing for the issues to be discussed and the appeal panel will make recommendations on what we should do next. Subject to an appeal being received, the guidance is expected to be published in September.

The draft guidance providing further information on this appraisal is available at http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11902#history.

Further information on our technology appraisals process is available in our document “A Guide to the Technology Appraisals Process” which can be accessed via the following link http://www.nice.org.uk/niceMedia/pdf/TAP.pdf.

I hope this email has been of some help in explaining the current status of this guidance and the next stage of the appraisal process. As soon as we have any further information on the progress of this appraisal we will upload this information onto the appraisal’s webpage.