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Access to the next wave of biologic therapies (Abatacept and Tocilizumab) for the treatment of rheumatoid arthritis in England and Wales: addressing treatment outside the current NICE guidance.

Chiu Y, Ostor AJ, Hammond A, Sokoll K, Anderson M, Buch M, Ehrenstein MR, Gordon P, Steer S, Bruce IN - Clin. Rheumatol. (2012)

Bottom Line: Specifically, we consider the use of tocilizumab or abatacept as the most appropriate treatments for some patients.At present, it is unclear the extent to which the proposed reform of the NHS will affect the role of NICE in providing guidance and setting standards of care.Until the full impact of the proposed changes are realized, individual funding requests will remain a valuable way of securing the optimal treatment for all patients suffering from RA.

View Article: PubMed Central - PubMed

Affiliation: Department of Rheumatology, Wirral University Teaching Hospital, Wirral, UK. yee.chiu@liverpool.ac.uk

ABSTRACT
Patients in England and Wales with rheumatoid arthritis (RA) receive treatment from the National Health Service (NHS) with therapies approved by the European Medicines Agency (EMA), under guidance from the National Institute for Health and Clinical Excellence (NICE). This document overviews the current NICE guidelines for the treatment of RA and identifies scenarios when such guidance may not represent the optimum management strategy for individual patients. Specifically, we consider the use of tocilizumab or abatacept as the most appropriate treatments for some patients. In such scenarios, it may be possible for the clinician to secure access to the required therapy through an application procedure known as an 'individual funding request', the process of which is described in detail here. At present, it is unclear the extent to which the proposed reform of the NHS will affect the role of NICE in providing guidance and setting standards of care. Until the full impact of the proposed changes are realized, individual funding requests will remain a valuable way of securing the optimal treatment for all patients suffering from RA.

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Related in: MedlinePlus

NICE guidance on the treatment of patients with rheumatoid arthritis. *Disease Activity Score 28 > 5.1 confirmed on ≥2 occasions, 1 month apart. †If the patient is intolerant of MTX or if MTX is considered inappropriate, then adalimumab, etanercept or certolizumab pegol (but not infliximab or golimumab) may be given as monotherapy. ‡An adequate response is defined as an improvement in DAS28 of ≥1.2. §Administered no more frequently than every 6 months; װAdalimumab, etanercept, infliximab or golimumab — there is currently no guidance for use of certolizumab pegol as a second anti-TNF agent. ¶If the patient is intolerant of MTX or if MTX is considered inappropriate, then adalimumab or etanercept may be given as monotherapy. CG clinical guideline, TA technology appraisal, MTA multiple technology appraisal
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Fig1: NICE guidance on the treatment of patients with rheumatoid arthritis. *Disease Activity Score 28 > 5.1 confirmed on ≥2 occasions, 1 month apart. †If the patient is intolerant of MTX or if MTX is considered inappropriate, then adalimumab, etanercept or certolizumab pegol (but not infliximab or golimumab) may be given as monotherapy. ‡An adequate response is defined as an improvement in DAS28 of ≥1.2. §Administered no more frequently than every 6 months; װAdalimumab, etanercept, infliximab or golimumab — there is currently no guidance for use of certolizumab pegol as a second anti-TNF agent. ¶If the patient is intolerant of MTX or if MTX is considered inappropriate, then adalimumab or etanercept may be given as monotherapy. CG clinical guideline, TA technology appraisal, MTA multiple technology appraisal

Mentions: NICE have issued overarching guidelines for the management of RA which address diagnosis, pharmacological treatment and disease monitoring [2]. To supplement these guidelines, NICE takes European Medicines Agency (EMA)-approved therapies and performs technology appraisals (TA) to provide guidance on their cost-effectiveness and use within the National Health Service (NHS). The outcomes of these appraisals and how they influence access to therapy are overviewed (Fig. 1).Fig. 1


Access to the next wave of biologic therapies (Abatacept and Tocilizumab) for the treatment of rheumatoid arthritis in England and Wales: addressing treatment outside the current NICE guidance.

Chiu Y, Ostor AJ, Hammond A, Sokoll K, Anderson M, Buch M, Ehrenstein MR, Gordon P, Steer S, Bruce IN - Clin. Rheumatol. (2012)

NICE guidance on the treatment of patients with rheumatoid arthritis. *Disease Activity Score 28 > 5.1 confirmed on ≥2 occasions, 1 month apart. †If the patient is intolerant of MTX or if MTX is considered inappropriate, then adalimumab, etanercept or certolizumab pegol (but not infliximab or golimumab) may be given as monotherapy. ‡An adequate response is defined as an improvement in DAS28 of ≥1.2. §Administered no more frequently than every 6 months; װAdalimumab, etanercept, infliximab or golimumab — there is currently no guidance for use of certolizumab pegol as a second anti-TNF agent. ¶If the patient is intolerant of MTX or if MTX is considered inappropriate, then adalimumab or etanercept may be given as monotherapy. CG clinical guideline, TA technology appraisal, MTA multiple technology appraisal
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3362712&req=5

Fig1: NICE guidance on the treatment of patients with rheumatoid arthritis. *Disease Activity Score 28 > 5.1 confirmed on ≥2 occasions, 1 month apart. †If the patient is intolerant of MTX or if MTX is considered inappropriate, then adalimumab, etanercept or certolizumab pegol (but not infliximab or golimumab) may be given as monotherapy. ‡An adequate response is defined as an improvement in DAS28 of ≥1.2. §Administered no more frequently than every 6 months; װAdalimumab, etanercept, infliximab or golimumab — there is currently no guidance for use of certolizumab pegol as a second anti-TNF agent. ¶If the patient is intolerant of MTX or if MTX is considered inappropriate, then adalimumab or etanercept may be given as monotherapy. CG clinical guideline, TA technology appraisal, MTA multiple technology appraisal
Mentions: NICE have issued overarching guidelines for the management of RA which address diagnosis, pharmacological treatment and disease monitoring [2]. To supplement these guidelines, NICE takes European Medicines Agency (EMA)-approved therapies and performs technology appraisals (TA) to provide guidance on their cost-effectiveness and use within the National Health Service (NHS). The outcomes of these appraisals and how they influence access to therapy are overviewed (Fig. 1).Fig. 1

Bottom Line: Specifically, we consider the use of tocilizumab or abatacept as the most appropriate treatments for some patients.At present, it is unclear the extent to which the proposed reform of the NHS will affect the role of NICE in providing guidance and setting standards of care.Until the full impact of the proposed changes are realized, individual funding requests will remain a valuable way of securing the optimal treatment for all patients suffering from RA.

View Article: PubMed Central - PubMed

Affiliation: Department of Rheumatology, Wirral University Teaching Hospital, Wirral, UK. yee.chiu@liverpool.ac.uk

ABSTRACT
Patients in England and Wales with rheumatoid arthritis (RA) receive treatment from the National Health Service (NHS) with therapies approved by the European Medicines Agency (EMA), under guidance from the National Institute for Health and Clinical Excellence (NICE). This document overviews the current NICE guidelines for the treatment of RA and identifies scenarios when such guidance may not represent the optimum management strategy for individual patients. Specifically, we consider the use of tocilizumab or abatacept as the most appropriate treatments for some patients. In such scenarios, it may be possible for the clinician to secure access to the required therapy through an application procedure known as an 'individual funding request', the process of which is described in detail here. At present, it is unclear the extent to which the proposed reform of the NHS will affect the role of NICE in providing guidance and setting standards of care. Until the full impact of the proposed changes are realized, individual funding requests will remain a valuable way of securing the optimal treatment for all patients suffering from RA.

Show MeSH
Related in: MedlinePlus