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NICE recommends new drugs for rheumatoid arthritis

Holding wrists with arthritis or joint pain

By Rebecca Jenkins

17 Jun 2021

Certain anti-TNF therapies are set to be made available within the NHS for moderate rheumatoid arthritis that has not responded to conventional treatment.  

NICE has published final draft guidance recommending adalimumab and etanercept, taken with methotrexate, for patients with a disease activity score (DAS28) of 3.2 to 5.1 where intensive therapy with two or more conventional disease-modifying antirheumatic drugs (DMARDS) has not controlled the disease. 

Adalimumab and etanercept may also be given as monotherapy when methotrexate is contraindicated or not tolerated, the guidance stated. 

The anti-TNF therapy infliximab, which is administered via intravenous injection, has also been recommended for use in this patient group, but only in combination with methotrexate. 

A fourth drug, abatacept, available in subcutaneous and intravenous formulations, did not meet the cost-effectiveness criteria and was not recommended for this group. 

Previously, NICE had only recommended biological treatments for severe rheumatoid arthritis, but the availability of biosimilar drugs prompted a review. 

Meindert Boysen, deputy chief executive director of the Centre for Health Technology Evaluation at NICE, said: ‘We are pleased that the introduction of biosimilars has lowered overall costs of treatment, allowing our independent committee to recommend biological treatment for more people with rheumatoid arthritis so they can enjoy a better quality of life.’ 

Welcoming the recommendation, Ailsa Bosworth, National Rheumatoid Arthritis Society (NRAS) national patient champion and former association chief executive, said people with inadequately controlled moderate disease would no longer have to suffer, often for many years, before they met the criteria to access advanced treatments.  

‘This is massive change and will improve the emotional and physical wellbeing of many thousands of people,’ she said. 

An NRAS study of more than 600 people with rheumatoid arthritis in the UK who had active disease, but were unable to access these advanced therapies, found 90% had experienced flares of their disease in the previous 12 months and almost a quarter experienced six or more flares. 

Full and final NICE guidance is expected to be issued in July. 


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