Go-ahead for NHS arthritis drugs

The drugs helps people with severe rheumatoid arthritis

Patients with severe rheumatoid arthritis are to be able to receive an advanced treatment for the condition on the NHS.

The National Institute for Clinical Excellence (NICE), the government's medicines watchdog, recommend that etanercept (Enbrel) and infliximab (Remicade) should be available to patients for whom conventional treatments have failed.

The decision could cost the NHS up to £78m per year.

NICE, whose decisions cover England and Wales, estimates 420,000 people are affected by rheumatoid arthritis.

Up to 15,000 are affected by the severe form of the disease.

It's a really great day for people with the most severe forms of rheumatoid arthritis

Neil Betteridge, Arthritis Care

They experience extreme joint pain, stiffness and inflammation, and many have to give up work.

This is the group which would benefit from the drugs which have been approved by NICE.

Etanercept is also recommend for children aged four to 17 who have juvenile idiopathic arthritis (JIA) in at least five joints and whose condition has not responded to other treatment.

Etanercept and infliximab (only in combination with methotrexate) are recommended for adults with active RA who have not responded well to conventional treatment by at least two different disease-modifying anti-rheumatic drugs.

Consultants should prescribe the drugs in accordance with guidance from rheumatology experts, and register dosages and any side effects to help monitor long-term effectiveness of the drugs.

Reduces inflammation

Both drugs are Tumour Necrosis Factor alpha blockers (anti-TNFs).

They work by switching off TNF, which stimulates cells to produce the inflammation response that leads to pain and swelling of the joints.

Rheumatoid arthritis

Rheumatoid arthritis affects more than 420,000 in England and Wales

About 15,000 have a very severe form of the disease

It is caused by inflammation in the lining of the joints and/or other organs

Sufferers are usually aged 30 to 50

Women are three times more likely to have RA

A year's treatment could cost up to £12,000, though there will be no extra funding to go with NICE's decision, leading campaigners to fear patients could still miss out if funding for the drug is not available in their local area.

The treatment is widely used in North America and Europe.

Andrew Dillon, chief executive of NICE, said the guidance was "positive news", allowing RA sufferers access to treatments previously been subject to postcode prescribing.

He added: "Rheumatoid arthritis is a progressive, disabling condition. The targeted use of these medicines can help people with this condition by delaying disease progression."

Ravinder Maini, rheumatology professor at the Kennedy Institute at Imperial College discovered the role TNF played in inflammation 15 years ago.

He told BBC News Online: "These drugs are very beneficial, and can reverse a patient's situation, increase mobility, improve quality of life and inhibit damage to joints."

Fergus Logan, chief executive of the Arthritis Research Campaign, said: "NICE's decision is fantastic news for those people with severe rheumatoid arthritis whose condition cannot be controlled by existing drugs.

"It will be interesting to see how quickly the recommendation filters through to the primary care trusts and hospitals, as no extra money is being made available to fund the treatment.

Fergus Logan, chief executive of the Arthritis Research Campaign, said: "NICE's decision is fantastic news for those people with severe rheumatoid arthritis whose condition cannot be controlled by existing drugs.

"It will be interesting to see how quickly the recommendation filters through to the primary care trusts and hospitals, as no extra money is being made available to fund the treatment."

'Overwhelming evidence'

Neil Betteridge, head of public policy for the charity Arthritis Care, said: "It's a really great day for people with the most severe forms of rheumatoid arthritis.

"The evidence in support of these drugs is overwhelming and NICE has done its job listening to all the relevant experts - not just the clinicians and the health economists but people living with RA."

He added: "We know £8-12,000 per year seems at first glance like an expensive treatment, but the cost to society of lost productivity, spending on benefits and extra demands on the health service such as GP visits, mean that to have withheld the treatment would have been an outrageously false economy.

"NICE has not always taken these wider savings into account when assessing new therapies so we are absolutely delighted that our case has been so influential this time."

Ailsa Bosworth, president of the National Rheumatoid Arthritis Society, who has suffered from RA for over 20 years, said she hoped NICE's decision would end the "blight" of postcode prescribing of anti-TNF treatments.

"Commissioners now need to secure funding immediately in order to ensure these treatments are provided for the people who need them."