NICE rejects second-line use of TNF-alpha drugs

The National Institute for Health and Clinical Excellence (NICE), which advises the UK's National Health Service on the use of drugs, excluding Scotland, has published a final appraisal document, preventing NHS rheumatoid arthritis patients from trying a different anti-tumor necrosis factor-alpha blocker if the first has been unsuccessful.

Anti-TNFs are prescribed for patients with active or severe forms of the disabling joint disease which is common in the elderly. At the moment it is common for rheumatologists to switch a patient to another anti-TNF if the first or previous treatment is poorly tolerated or lacks effectiveness. But, at an average price of over L10,000 ($19,918) per patient a year, the NICE ruled that these drugs are not cost effective.

Between 20,000 and 40,000 people in England and Wales are taking an anti-TNF at any time, and 50% have needed to switch treatments at least once, according to UK charity the Arthritis and Musculoskeletal Alliance.