National Institute for Health and Clinical Excellence (NICE)
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NICE approves abatacept for rheumatoid arthritis

Patients with rheumatoid arthritis can now be offered abatacept in certain circumstances, following final guidance from NICE.

Around 400,000 people currently have rheumatoid arthritis in the UK, forcing approximately a third of people with the condition to stop work within 2 years of its onset.

Rheumatoid arthritis is commonly managed with disease-modifying anti-rheumatic drugs (DMARDs), which are used to reduce progression of the disease and reduce long-term disability.

Original guidance from NICE on abatacept did not recommend the drug as a treatment option after conventional DMARDs, as it was not cost-effective when compared to alternatives such as adalimumab.

However, following the introduction of a patient access scheme which abatacept's manufacturer agreed with the Department of Health, NICE conducted a rapid review of this guidance, and now recommends abatacept in certain circumstances.

NICE says abatacept can be used with methotrexate as an option for treating people with rheumatoid arthritis only if the disease has responded inadequately to two conventional non-biological DMARDs including methotrexate, and it is used in line with the recommendations for other biological DMARDs in NICE guidance on rheumatoid arthritis.

Furthermore, the drug should be made available by the manufacturer at a discounted price as part of the patient access scheme agreed with the Department of Health.

NICE has previously recommended abatacept and other drugs as an option for people with RA if patients have not responded adequately to one or more TNF inhibitors, and who cannot receive rituximab because it is contraindicated or withdrawn because of an adverse event.

Professor Carole Longson, Director of the Health Technology Evaluation Centre at NICE, said: “This guidance, resulting from the rapid review of TA234, recommends that abatacept should be an option at an earlier stage after treatment with conventional drugs has failed.

"We have already recommended the TNF inhibitors adalimumab, etanercept, infliximab, certolizumab pegol and golimumab, and also the drug tocilizumab, for some people with rheumatoid arthritis as options for use at this stage.

She added: "This guidance will widen the choice of treatments available at this stage of the treatment pathway, by offering abatacept in specific clinical circumstances, and only if the manufacturer provides it with the discount agreed as part of the patient access scheme."

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