NICE Appraisal Of Rituximab And Adalimumab For The Treatment Of Arthritis

The National Institute for Health and Clinical Excellence (NICE) has published
final guidance on the use of rituximab (Mabthera) for the treatment of rheumatoid
arthritis and adalimumab (Humira) for the treatment of psoriatic arthritis, as part of its
rapid single technology appraisal (STA) work programme.


NICE recommends:


-- Rituximab in combination with methotrexate is recommended as a treatment
option for adults with severe active rheumatoid arthritis who have had an
inadequate response to or intolerance of other disease modifying anti-
rheumatic drugs. This should include treatment with at least one tumour
necrosis factor (TNF) inhibitor therapy


-- Treatment with rituximab plus methotrexate should be continued only if there
is an adequate response following initiation of therapy


-- Adalimumab is recommended as a treatment option for adults with active and
progressive psoriatic arthritis when the person has peripheral arthritis with
three or more tender joints and three or more swollen joints, and the psoriatic
arthritis has not responded to adequate trials of at least two standard disease-
modifying anti-rheumatic drugs


-- Adalimumab treatment should be discontinued after 12 weeks in adults whose
psoriatic arthritis has not shown an adequate response


Andrew Dillon, Executive Lead for the appraisal said: "Following further
clarification from the manufacturer on the economic analysis of rituximab, the
committee has assessed that these drugs represent the right approach for the NHS

to take in the treatment of two severe forms of arthritis. It is estimated that up to 1%
of the population suffers from rheumatoid or psoriatic arthritis, which are both very
distressing, causing a great deal of pain or discomfort and impacting on an
individual's ability to go about their daily life. The approval of both of these drugs is
good news for anyone suffering from rheumatoid or psoriatic arthritis - by
recommending the use of these drugs, people in England and Wales with these
conditions can be reassured that they have access to effective treatments when they
need them."


About NICE


1. The National Institute for Health and Clinical Excellence (NICE) is the independent
organisation responsible for providing national guidance on the promotion of good health
and the prevention and treatment of ill health.


2. NICE produces guidance in three areas of health:


-- public health - guidance on the promotion of good health and the prevention of ill
health for those working in the NHS, local authorities and the wider public and
voluntary sector


-- health technologies - guidance on the use of new and existing medicines,
treatments and procedures within the NHS


-- clinical practice - guidance on the appropriate treatment and care of people with
specific diseases and conditions within the NHS.


About the guidance


3. The adalimumab and rituximab guidance is available at nice.uk/TA125 and
nice.uk/TA126.


4. Rheumatoid arthritis (RA) is a chronic, disabling condition characterised by inflammation
of the synovial tissue of the joints, causing pain, swelling and stiffness and progressive
joint destruction. It affects between 0.5% and 1% of the population, or approximately
400,000 people in England and Wales. Of these, approximately 15% have severe
disease. RA affects three times as many women as men and has a peak age of onset of
40-70 years.


5. Psoriatic arthritis (psoriatic arthropathy) is an inflammatory joint disease closely
associated with the skin disease psoriasis. An estimated 5-7% of all people with
psoriasis have psoriatic arthritis, but it is much more common in those with extensive
psoriasis. Psoriatic arthritis has an overall prevalence of between 0.1% and 1%. It affects
men and women equally and its incidence peaks between the ages of 30 and 55 years.


nice.uk


View drug information on Humira.