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Published on 12 March 2013

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Abatacept positive guidance from NICE

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The National Institute for Health and Clinical Excellence (NICE) has announced today that it recommends the use of abatacept in combination with methotrexate as an option for treating rheumatoid arthritis in adults whose disease has responded inadequately to two conventional disease-modifying antirheumatic drugs (DMARDs), including methotrexate.(1)
This recommendation enables the use of abatacept earlier in the treatment pathway providing physicians with greater treatment options and benefitting the patients who suffer from this disabling chronic disease.
NICE currently recommends a group of medicines represented primarily by anti-TNFs as first-line biologic treatment of RA following the failure of conventional DMARDs. As a T-cell co-stimulation blocker, abatacept acts differently than the anti-TNFs and has demonstrated robust short term and long term efficacy and safety data.(2–4)
During the review process of abatacept IV, the Committee heard from clinical specialists and patient experts who emphasised the importance of having a choice of treatments for people whose disease has not responded adequately to initial treatment with conventional DMARDs.
Speaking about the latest announcement from NICE, Dr Andrew Östör, Consultant Rheumatologist, University of Cambridge, said, “We have been waiting a long time for this positive opinion – it is wonderful news for patients as it means we will have greater treatment options available to us.  How rheumatoid arthritis affects a person is individual and what therapy works well for one may be ineffective in another. Choice therefore is critical in order to offer our patients the best treatment for them to combat their disease.”
In the UK, nearly 700,000 people are affected by RA, a condition which severely impacts on quality of life. It causes chronic pain, stiffness, swelling and fatigue due to the joint damage, making it difficult to move about freely. More than half of people have to give up their jobs within six years of being diagnosed.(5,6)
Ailsa Bosworth, Chief Executive and Founder of NRAS (National Rheumatoid Arthritis Society) said, “This is great news for patients suffering from rheumatoid arthritis. Finding the right treatment for RA patients is critical and for too long many clinicians in England haven’t been able to exercise clinical judgement in regard to using Orencia at an earlier stage in the biologic pathway. Now this decision is final, it means that they can consider it at the same time as they’re thinking about other potential treatments. We need more choices for treating RA.”
This recommendation from NICE will replace technology appraisal guidance 234 issued in August 2011.
References:
  1. National Institute for Health and Clinical Excellence. Final Appraisal Document (FAD) – Abatacept for treating rheumatoid arthritis after the failure of conventional disease-modifying antirheumatic drugs (rapid review of technology appraisal guidance 234), March 2013. http://guidance.nice.org.uk/TA/Wave24/27/FAD/FinalAppraisalDetermination/pdf/English
  2. Westhovens R, Kremer JM, Emery P, Russell AS, Li T, Aranda R et al. Consistent safety and sustained improvement in disease activity and treatment response over 7 years of abatacept treatment in biologic naive patients with rheumatoid arthritis. EULAR. Abstract . 2009.
  3. Kremer JM, Russell AS, Emery P, Abud-Mendoza C, Szechinski J, Becker JC et al. Abatacept demonstrates consistent safety and sustained improvements in efficacy through 5 years of treatment in biologic naive patients with rheumatoid arthritis. EULAR . 2009
  4. Schiff M, Keiserman M, Codding C, Songcharoen S, Berman A, Nayiager S et al. Efficacy and safety of abatacept or infliximab vs placebo in ATTEST: a phase III, multi-centre, randomised, double-blind, placebo-controlled study in patients with rheumatoid arthritis and an inadequate response to methotrexate. Ann Rheum Dis 2008; 67(8):1096-1103
  5. National Rheumatoid Arthritis Society. What is RA? Available at http://www.nras.org.uk/about_rheumatoid_arthritis/what_is_ra/what_is_ra.aspx (Last accessed 05.11.12)
  6. National Rheumatoid Arthritis Society. The economic burden of rheumatoid arthritis. Available at http://www.nras.org.uk/includes/documents/cm_docs/2010/e/1_economic_burden_of_ra_final_30_3_10.pdf (Last accessed 05.11.12)


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