Sequential use of anti-TNFs rejected by NICE

The National Institute for Health and Clinical Excellence (NICE) has today made a preliminary ruling that will prevent people with severe rheumatoid arthritis from trying a second ‘anti-TNF’ treatment if the first does not work for their condition.  Although response to the decision has been invited, rarely do decisions change between preliminary and final stages.

This means that those people for whom one treatment has failed now have only one further option.  If this too fails them they will be forced to return to treatments which have not worked for them in the past.  

This decision comes despite an appeal made by the Arthritis and Musculoskeletal Alliance, of which Arthritis Care chief executive Neil Betteridge is chair, in April 2007, which had forced NICE to reconsider the evidence and its position.

There is a good deal of evidence that where one anti-TNF does not work, another may be very effective.  Each treatment works in a different way, meaning that for some people one will be much more effective than another, but it is difficult to know which will be best in advance of treatment.  Therefore, cost appears to be the key factor in this decision, ignoring the very real difference the treatments could make to people’s lives.

Although people will be able to have access to a new therapy, rituximab, the choices now available to people with rheumatoid arthritis have been severely restricted.

If you need support and information on this or any issue regarding your arthritis, please call our helpline on 0808 800 4050, open 10am-4pm weekdays.