NICE have once again said 'no' to the use of Tocilizumab in the NHS
NRAS statement in regard to NICE decision on Tocilizumab.The NRAS are devastated to learn that NICE have once again said ‘no’ to the use of Tocilizumab in the NHS.
This is indeed a bitter blow for patients who have failed on Anti-TNF, particularly those who have sero-negative RA and for whom the only other biologic drug option, Rituximab, may not be suitable. There is a clear unmet need for people who fail on Anti-TNF therapy. Approximately 25-30% are primary non-responders to biologic TNF inhibition. Anther 20% are secondary non-responders, losing initial efficacy over a period of time. This subgroup is cumulative in number and may be as high as 50% over the course of 5 years of disease duration.
It is important to state that tocilizumab has been investigated extensively across a range of indications and the data is consistently strong and very similar to that observed with anti-TNF. The joint protection data is also compelling. The safety and tolerability are favourable out to 3.5 years (data presented at the ACR 2009).
The burden of this disease is, I believe, not at all adequately understood by the NICE Appraisal Committee, and the true cost of returning people to palliative care significantly under-estimated. Not only do the direct costs need to be considered (including joint replacement and frequent hospitalisation) but also the indirect costs such as the need for carers, loss of income, career limitation, payment of benefits and the management of comorbidities associated with steroids (not least of which are cardio-and cerebrovascular risk and osteoporosis). This needs to be weighed against the cost of successful biologic therapy in such patients.
Thus, in order to properly tackle the burden of rheumatoid arthritis, clinicians and patients should have access to the widest range of effective biologic therapies.
We are at a complete loss to understand NICE’s decision here, particularly as the cost is the same as the TNFs already on the market and in the light of the lack of clarity and decision over TNF switching, the situation for the people with RA who are affected by such decisions, is appalling.