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NICE warns against abatacept for RA treatment


The National Institute for Health and Clinical Excellence (NICE) has today issued final guidance to the National Health Service (NHS) on the use of abatacept (Orencia) as a second-line treatment for people with rheumatoid arthritis.

The guidance does not recommend abatacept in combination with methotrexate for treating rheumatoid arthritis in adults whose disease has responded inadequately to one or more conventional non-biological disease-modifying anti-rheumatic drugs (DMARDs), including methotrexate.

The recommendations say that people currently receiving abatacept for treating rheumatoid arthritis should have the option to continue therapy until they and their clinicians consider it appropriate to stop.

NICE has already recommended a range of biological treatments for rheumatoid arthritis. Adalimumab, etanercept, infliximab, certolizumab pegol and golimumab are options for second-line use. This is the same point in the treatment pathway at which abatacept is currently being considered.

NICE also recommends rituximab for adults with severe active rheumatoid arthritis who have had an inadequate response to at least one tumor necrosis factor (TNF) inhibitor.

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In addition, for people who cannot take rituximab, following an inadequate response to at least one TNF inhibitor, NICE recommends adalimumab, etanercept, infliximab, tocilizumab, abatacept and golimumab.

“NICE has previously issued a positive recommendation for the use of abatacept, in certain circumstances, to help people with rheumatoid arthritis,” said Professor Carole Longson, Health Technology Evaluation Centre Director at NICE.

“However, the evidence considered by the Appraisal Committee did not support using abatacept as a second-line treatment option.

“Indeed, the manufacturer of abatacept had noted that their product would not be cost-effective for second-line use when compared to a range of alternatives including adalimumab, etanercept and certolizumab pegol.

“NICE has already recommended a range of biological treatments for rheumatoid arthritis, providing potential treatment options for people with this condition.”


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