The National Institute for Health Care and Excellence recently released guidance for the use of biologics to treat rheumatoid arthritis.
The recommendations replace technology appraisal guidance previously issued by the institute related to adalimumab, etanercept, infliximab and certolizumab pegol for the treatment of rheumatoid arthritis (RA); golimumab for methotrexate-naïve RA; and abatacept for the treatment of RA when treatment with conventional disease-modifying anti-rheumatic drugs (DMARDs) has failed. It also partially updates the use of golimumab for patients with RA who have failed treatment with previous DMARDs and the use of tocilizumab for RA.
According to the guidance document, abatacept (Orencia, Bristol-Myers Squibb), adalimumab (Humira, AbbVie), certolizumab pegol (Cimzia, UCB), etanercept (Enbrel, Amgen), golimumab (Simponi, Janssen), infliximab (Remicade, Remsina, Inflectra) and tocilizumab (RoActemra, Roche) are recommended in combination with methotrexate only in the presence of a DAS28 score of greater than 5.1 and with a lack of response to “intensive therapy” with a combination of conventional DMARDs. The use of these treatments in combination with methotrexate are further contingent upon agreement from the manufacturers to continue to provide abatacept, certolizumab pegol, golimumab and tocilizumab as an agreed patient access scheme. Monotherapy of adalimumab, certolizumab pegol, etanercept or tocilizumab is only recommended for patients who cannot take methotrexate and who met the previously noted criteria.
Other provisions of the guidance include a requirement to begin the patient on the least expensive treatment first, discontinuance of the biologic after 6 months in the absence of a EULAR response and to withdraw treatment after 6 months if a moderate response is not maintained. Patients who began biologic therapy prior to the release of the guidance may continue treatment until their NHS clinicians advise them to discontinue the treatment.