Anger over arthritis drug refusal

Rheumatoid arthritis can be extremely debilitating

Campaigners have condemned a health watchdog's final decision not to recommend a new drug for severe rheumatoid arthritis for NHS use.

The National Institute for Health and Clinical Excellence, said abatacept was not good value for money.

The National Rheumatoid Arthritis Society, whose appeal was rejected, described the decision as "short sighted and perverse".

Drug maker Bristol-Myers Squibb claimed 3,500 UK patients could have benefited.

For many patients, abatacept provides their last chance of controlling the disease Ailsa Bosworth National Rheumatoid Arthritis Society

There are an estimated 400,000 people in the UK with rheumatoid arthritis, a disease in which inflammation attacks the joints.

Approximately 40,000 have a severe form of the disease, and while there are a succession of drugs which offer some control over the disease in many cases, a small number of patients do not respond to these.

Some experts say that, for them, abatacept, under its trade name Orencia, offers a "last chance" of improving their quality of life.

However, it costs at least £9,000 a year, and NICE, which makes decisions covering NHS authorities in England and Wales, ruled last year that it did not offer enough benefit to justify the cost.

This week, a second NICE appraisal committee agreed with that verdict.

'Kick in the teeth'

Dr Andrew Dillon, NICE's chief executive, said that it had approved a succession of rheumatoid arthritis drugs, giving people access to "effective treatments", and said that people currently being given abatacept would be allowed to continue therapy.

Dr Andrew Bamji, the president of the British Society for Rheumatology, said that it was a "disappointing decision".

"NICE is effectively denying desperate patients any last hope of remission from their disease. This decision is like a kick in the teeth for a group of severely disabled patients."

National Rheumatoid Arthritis Society chief executive Ailsa Bosworth said that the decision condemned some patients to a "lifetime of misery". "For many patients, abatacept provides their last chance of controlling the disease.

"Without this drug, people with severe rheumatoid arthritis will have to return to medicines they have already failed on or will have to take large doses of steroids which are associated with extremely unacceptable side effects.

"We believe this is a perverse and very short-sighted decision by NICE."

Professor Alan Silman, medical director of the Arthritis Research Campaign, said the NICE decision was disappointing - but not surprising. He said: "Abatacept offers a novel approach to treating severe RA patients and in clinical trials it has been shown to be effective when other new agents have failed.

"It was rejected on the grounds of high cost, but what needs to be done now is to identify the patients for whom this drug would be effective - both clinically and cost effective.

"We believe there should be a place for this drug in the range of options available to doctors in treating RA patients."