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Prescribers “not following guidance”


There are fears some doctors treating rheumatoid arthritis (RA) are not following advice which has recently been backed by a new report.

Currently, patients are given TNF inhibitors, which block the action of an inflammatory signalling molecule called tumour necrosis factor.

When one anti-TNF agent fails the normal practice is to try another — a process known as “cycling”.

Preliminary guidance from the NHS watchdog the National Institute for health and Clinical Excellence (NICE) has now advised against this strategy. It says TNF inhibitor treatment should be halted and patients switched to a different class of drug instead.

However, some doctors are reported to be unwilling to change their treatment approach.

Now a new study supports the NICE guidance. It shows that when patients stop responding to a TNF inhibitor it is more effective to treat them with the antibody drug MabThera than with another anti-TNF therapy.

MabThera, the drug rituximab, works in a completely different way by targeting specific immune system cells involved in RA.

One of the researchers, Professor Rob Moots, from Aintree University Hospitals, said: “These findings confirm that switching to an alternative biological agent, such as rituximab, in the subset of RA patients who don’t respond to a first anti-TNF agent, can provide major benefits.”

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