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SMC recommends abatacept


The Scottish Medicines Consortium (SMC) has announced today that abatacept (Orencia®) has been accepted for use within NHS Scotland, in combination with methotrexate (MTX), as a first-line biologic agent for adults with rheumatoid arthritis (RA), after failure with two conventional DMARDs.(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.
Speaking about the decision, Professor Iain McInnes, Director, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow said, ‘This is good news for clinicians in Scotland as it will increase the number of treatment options that we have to help our patients with this debilitating disease.
Increasingly we recognise that different patients respond to distinct medicines – more choice of medicines, carefully used, should improve our overall approach to the treatment of arthritis. Having abatacept as another option earlier in the treatment pathway increases such choice and in consequence this is a development which is to be welcomed by physicians and patients alike.’
SMC 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 to the anti-TNFs and has demonstrated robust short term and long term efficacy and safety data.(2,3,4) During the review process of abatacept IV, the SMC sought advice from clinical experts who emphasised the importance of having a choice of treatments particularly for patients who cannot be treated with anti-TNFs.(1)
In Scotland, up to 217,000 people are affected by RA, a condition which severely impacts on quality of life.(5) It causes chronic pain, stiffness, swelling and fatigue due to the joint damage, making it difficult to move about freely.(6) The largest ever study of RA patients of working age in Scotland carried out by the National Rheumatoid Arthritis Society (NRAS) found that more than half of RA patients had to give up work prematurely. Of these patients, more than half gave up work within only one year of diagnosis with 80% stopping work within six years.(7)
Ailsa Bosworth, Chief Executive and Founder of NRAS said ‘This decision is great news for people with rheumatoid arthritis. It is a disabling disease that often has a huge impact on the lives of patients and their families, which means it is critical for patients to find the right treatment that works for them. Having more treatment options available at an earlier stage means that patients can find the right treatment sooner, allowing them and their families to live as normal a life as possible.’
This advice published by the SMC will replace advice issued in September 2011.
  1. Scottish Medicines Consortium (SMC). Abatacept for 250mg powder for concentrate for solution for infusion (Orencia®), March 2013. SMC No. (719/11). Available
  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. The Scottish Inflammatory Diseases and Rheumatology Industry Group. Delivery of RA Services in Scotland: The View of Healthcare Professionals. Available at: (Last accessed: 19.03.13)
  6. National Rheumatoid Arthritis Society. What is RA? Available at (Last accessed 19.03.13)
  7. National Rheumatoid Arthritis Society. RA and work. 2010. Available at: (Last accessed: 19.03.13)

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