NPC Archive Item: NICE rejects abatacept for the treatment of rheumatoid arthritis

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The National Institute for Health and Clinical Excellence (NICE) has published guidance on abatacept for the treatment of rheumatoid arthritis.

The guidance states that:

Abatacept is not recommended for the treatment of people with rheumatoid arthritis

Patients currently receiving abatacept for the treatment of rheumatoid arthritis should have the option to continue therapy until they and their clinicians consider it appropriate to stop.

Abatacept▼ (Orencia , Bristol-Myers Squibb) is a selective T-cell co‑stimulation modulator. It is designed to block a key co‑stimulatory signal required for T-cell activation. Abatacept is licensed for use in combination with methotrexate for the treatment of moderate to severe active rheumatoid arthritis in adult patients who have had an insufficient response or intolerance to other disease-modifying anti-rheumatic drugs (DMARDs), including at least one tumour necrosis factor a (TNF-α) inhibitor.

The NICE Appraisal Committee recognised the innovative nature of abatacept, the severity of rheumatoid arthritis and the limitations around economic modeling with these drugs. However, it concluded that abatacept would not be a cost-effective use of NHS resources.

NICE has previously recommended the TNF-α inhibitors , adalimumab▼, etanercept▼ and infliximab▼ for the treatment of rheumatoid arthritis in selected patients who have already tried methotrexate and another DMARD. Further guidance on the sequential use of these after failure of the initial TNF-α inhibitor is expected in September 2008. NICE has also recommended rituximab in combination with methotrexate as an option for patients with severe disease who have had an inadequate response to, or intolerance of, other DMARDs, including treatment with at least one TNF α inhibitor. Anakinra was not recommended by NICE for the treatment of rheumatoid arthritis, except in the context of a controlled, long-term clinical study.

A NICE clinical guideline on the management and treatment of rheumatoid arthritis in adults is expected in February 2009.

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