Health watchdog's U-turn over drugs for rheumatoid arthritis

The National Institute for Health and Clinical Excellence (Nice) issued guidance today which effectively reverses a decision it made two years ago to deny a range of new-wave drugs to sufferers.

In patients with inflammatory diseases like rheumatoid arthritis a protein called TNF is overproduced in the body, which causes inflammation, pain and damage. Anti-TNF drugs block the action of the protein and so can reduce this inflammation.

In 2008, Nice was criticised after it ruled patients would not be able to try a second anti-TNF drug if their first attempt at anti-TNF therapy failed.

But charities, which appealed the decision, called it a "prescription for pain" and said moving from one therapy to a second or third has been established practice for years.

Data from the British Society for Rheumatology Biologics Register suggests around 70 per cent of patients will get a good response from a second anti-TNF.

Nice also rejected the drug abatacept (Orencia) for arthritis in 2008, meaning the number of effective therapies was cut from five to two.

And in March this year, Nice issued guidance recommending the use of a drug called rituximab (MabThera), but saying adalimumab (Humira), etanercept (Enbrel) and infliximab (Remicade) could only be used in the context of research, even for those patients who had failed on one anti-TNF. The watchdog also rejected Orencia in that guidance.

Today, in new draft guidance, Nice recommended MabThera as the treatment for patients who have failed on an anti-TNF or who have not responded to other disease-modifying anti-rheumatic drugs.

But it also recommended Humira, Enbrel, Remicade, and Orencia for patients who have failed on one anti-TNF or who have not responded to other disease-modifying anti-rheumatic drugs, and who cannot take MabThera.

Professor Alan Silman, medical director of Arthritis Research UK, said: "Nice's decision will enable us to support both researchers and clinicians to move closer to what we regard as the medical equivalent of the Holy Grail – personalised medicine – with choice of treatment being more targeted and tailored towards individual needs."