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Healthcare guidance body NICE has yesterday published final draft guidance recommending 4 drugs for treating a form of arthritis in children and young people.

NICE has provisionally recommended abatacept (Orencia, Bristol-Myers Squibb), adalimumab (Humira, AbbVie), etanercept (Enbrel, Pfizer) and tocilizumab (RoActemra, Roche), within their marketing authorisations, as options for treating juvenile ideopathic arthritis (JIA).

Affecting around 10,000 children and young people in the UK, JIA describes a group of conditions that involve joint inflammation which lasts for more than 6 weeks in people under 16 years of age.

JIA can affect children and young people of any age and causes pain, swelling and limitation of movement, which can change from day to day. The condition, which has no known cause, may start with symptoms such as a fever or rash, with joints eventually becoming swollen and inflamed.

In more severe cases JIA can cause growth impairment, joint contractures, joint disease requiring joint replacements (it is estimated that between 7% and 28% of children with JIA need joint replacements), eye problems and other problems outside of the joints such as inflammatory bowel disease and psoriasis, as well as permanent disability.

JIA can have a significant impact on a person’s ability to perform day-to-day activities and impair their personal and social functioning and development. Children and young people with JIA often miss out on schooling and other childhood activities, and as adults they may be limited in their ability to work. JIA may also have a considerable impact on the family of the child, including parents and carers who may need to miss work to take children to appointments.

The aims of treatment are to control joint pain and inflammation, reduce joint damage, disability and loss of function and maintain or improve quality of life. However, despite treatment, about a third of children with JIA will not achieve remission from the condition and will need further rheumatological care as adults.

The 4 drugs that are the subject of this draft guidance belong to a group of drugs called disease-modifying anti-rheumatic drugs (DMARDs) which aim to reduce or halt joint damage by reducing or stopping disease activity. They are all licensed for use where previous treatment has been associated with an inadequate response or with intolerance.

Professor Carole Longson, NICE Health Technology Evaluation Centre Director, said yesterday: “Juvenile idiopathic arthritis is a progressive degenerative condition that not only affects the quality of life of the child or young person with the disease, but can also affect the quality of life of their carers and family. The Committee heard there is a link between the length of time the disease remains uncontrolled and the amount of joint damage and growth impairment. They also heard that being able to access effective treatments at an early stage of the disease can help improve long-term outcomes. We are therefore pleased to be able to recommend these drugs as options for children and young people with juvenile idiopathic arthritis in today’s draft guidance.”

The draft guidance states that when more than 1 drug is suitable, treatment should be started with the least expensive drug, taking into account administration costs, the dose needed and the product cost per dose.

The draft guidance is now with consultees, who have the opportunity to appeal against it. Once NICE issues its final guidance on a technology, it replaces local recommendations across the country.

For more information call the NICE press office on 0300 323 0142 or out of hours on 07775 583 813.

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

Our products and resources are produced for the NHS, local authorities, care providers, charities, and anyone who has a responsibility for commissioning or providing healthcare, public health or social care services.

To find out more about what we do, visit our website:www.nice.org.uk and follow us on Twitter: @NICEComms.