Nice eases drug restrictions for rheumatoid arthritis sufferers

Thousands of people with rheumatoid arthritis could be given the chance to try new drugs following a U-turn by the health watchdog.

The National Institute for Health and Clinical Excellence (Nice) has issued guidance which effectively reverses a decision it made two years ago to deny a range of drugs to sufferers. In 2008, Nice said patients would not able able to try a second TNF (tumour necrosis factor)-alpha inhibitor if a first attempt at therapy failed. But charities called it a "prescription for pain" and said moving from one therapy to a second or third has been established practice for years.

Data from the British Society for Rheumatology Biologics Register suggests that about 70 per cent of patients will get a good response from a second lot of therapy if the effects of the first start to wane. Nice also rejected the drug abatacept (Orencia) for arthritis in 2008, meaning the number of effective therapies was cut from five to two.

In March this year, Nice issued new guidance recommending the use of a drug called rituximab, but said others could only be used in research. In new draft guidance, Nice now recommends rituximab as the treatment for patients who have failed or who have not responded to other disease-modifying anti-rheumatic drugs. It also recommended others for patients who failed on one TNF inhibitor or have not responded to other drugs.

Dr Carole Longson, the director of health technology evaluation centre at Nice, said: "The focus of this appraisal was to look at treatment options when a TNF inhibitor has not worked or when it has lost its effect. The evidence suggests that rituximab works in this context and is cost-effective. However, not all patients are able to take rituximab, so the appraisal committee has recommended that [other drugs] adalimumab, etanercept, infliximab or abatacept may be given. We hope this wider choice of options will mean people will be able to manage their rheumatoid arthritis more effectively."