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NICE could deny access to powerful arthritis drugs

NICE has issued draft guidance, which could see over 40,000 rheumatoid arthritis patients denied access to a powerful range of medications and leave them facing high levels of pain

The National Institute for Health and Clinical Excellence (NICE) has issued draft guidance, which could see over 40,000 rheumatoid arthritis (RA) patients denied access to a powerful range of medications and leave them facing high levels of pain.

NICE has decided not to recommend the use of anti-TNF (tumour necrosis factor inhibitors) in patients who have not responded to a previous course of TNF medication. The drugs named in the draft guidance are adalimumab, etanercept and infliximab, which although effective, are expensive, with the cheapest course being about £100 a week per patient.

"This decision is another nail in the coffin for the treatment of RA in England and Wales," said Ailsa Bosworth, chief executive of the National Rheumatoid Arthritis Society (NRAS). "NICE are rewriting the rules of RA treatment in this country, ignoring the clinical effectiveness of drugs and ignoring the views of patients and clinicians."

According to NRAS, moving patients from one TNF therapy to a second, and in some cases a third, has been established practice in the UK for some years, so this is not a new therapeutic option, which is being banned. The Society expressed its concern that limiting the number of available RA treatments could mean patients who are diagnosed with the disease in their 20s and 30s could face 40-plus years of disability and unemployment through sickness.

NRAS also claims that the NICE draft guidance is not in keeping with the recommendations of Working for a Healthier Tomorrow, a report by Dame Carol Black, which states that people should be supported to remain in work.

Bosworth, an RA sufferer herself, has attended NICE appraisal/appeal meetings and has said that she can recall only one occasion when she or any other patient expert present had been asked a question by a member of the committee.

"They seem fundamentally uninterested in the patient quality of life issues which matter to real people," Bosworth said of the NICE appraisal/appeal committee. "The involvement and views of patients and patient groups in the NICE process is just a token gesture and is not taken seriously."

21st July 2008

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