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NICE Appraisal Of Rituximab And Adalimumab For The Treatment Of Arthritis
23 Aug 2007
As edited by Joint-Pain-Forum.com
The National Institute for Health and Clinical Excellence
(NICE) has published final guidance on the use of rituximab (Mabthera)
for the treatment of rheumatoid arthritis and adalimumab (Humira) for
the treatment of psoriatic arthritis, as part of its rapid single
technology appraisal (STA) work programme.
-- Rituximab in combination with methotrexate is recommended as a
treatment option for adults with severe active rheumatoid arthritis who
have had an inadequate response to or intolerance of other disease
rheumatic drugs. This should include treatment with at least one tumour
necrosis factor (TNF) inhibitor therapy
-- Treatment with rituximab plus methotrexate should be continued only
if there is an adequate response following initiation of therapy
-- Adalimumab is recommended as a treatment option for adults with
active and progressive psoriatic arthritis when the person has
peripheral arthritis with three or more tender joints and three or more
swollen joints, and the psoriatic arthritis has not responded to
adequate trials of at least two standard disease-
modifying anti-rheumatic drugs
-- Adalimumab treatment should be discontinued after 12 weeks in adults
whose psoriatic arthritis has not shown an adequate response
Andrew Dillon, Executive Lead for the appraisal said: "Following
further clarification from the manufacturer on the economic analysis of
rituximab, the committee has assessed that these drugs represent the
right approach for the NHS to take in the treatment of two severe forms
of arthritis. It is estimated that up to 1% of the population suffers
from rheumatoid or psoriatic arthritis, which are both very
distressing, causing a great deal of pain or discomfort and impacting
on an individual's ability to go about their daily life. The approval
of both of these drugs is good news for anyone suffering from
rheumatoid or psoriatic arthritis - by recommending the use of these
drugs, people in England and Wales with these conditions can be
reassured that they have access to effective treatments when they need
1. The National Institute for Health and Clinical Excellence (NICE) is
the independent organisation responsible for providing national
guidance on the promotion of good health and the prevention and
treatment of ill health.
2. NICE produces guidance in three areas of health:
-- public health - guidance on the promotion of good health and the
prevention of ill health for those working in the NHS, local
authorities and the wider public and voluntary sector
-- health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS
-- clinical practice - guidance on the appropriate treatment and care
of people with specific diseases and conditions within the NHS.
About the guidance
3. The adalimumab and rituximab guidance is available at http://www.nice.org.uk/TA125 and http://www.nice.org.uk/TA126.
4. Rheumatoid arthritis (RA) is a chronic, disabling condition
characterised by inflammation of the synovial tissue of the joints,
causing pain, swelling and stiffness and progressive joint destruction.
It affects between 0.5% and 1% of the population, or approximately
400,000 people in England and Wales. Of these, approximately 15% have
severe disease. RA affects three times as many women as men and has a
peak age of onset of 40-70 years.
5. Psoriatic arthritis (psoriatic arthropathy) is an inflammatory joint
disease closely associated with the skin disease psoriasis. An
estimated 5-7% of all people with psoriasis have psoriatic arthritis,
but it is much more common in those with extensive psoriasis. Psoriatic
arthritis has an overall prevalence of between 0.1% and 1%. It affects
men and women equally and its incidence peaks between the ages of 30
and 55 years.
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