A decision by NICE (National Institute for Clinical Excellence) means that rheumatoid arthritis (RA) patients will not have access to a second anti-TNF treatment if the first one is found to be unsuitable. The Arthritis and Musculoskeletal Alliance says this latest decision seems to have forgotten all about patient choice in England, while those in Scotland will be able to move from one treatment to another if the first one proved unsuitable.

Doctors decide to prescribe an anti-TNF drug after considering six products that are available in the UK. If the first treatment does not work, or does not suit the patient, they have been able to move onto another therapy in the same category. This will no longer be the case – the choices will no longer be there, thus reducing patients’ chances of ever hitting on successful outcomes. According to the Arthritis and Musculoskeletal Alliance, this option to use products sequentially is encouraged in other European countries.

Over 700,000 people in the UK are affected by inflammatory arthritis, many of whom require access to these drugs. About 5% of them, those with the most severe forms of RA, may die within five years if they do not get the right treatment. An RA patient receiving an anti-TNF has a significantly higher chance of remaining in his/her job – he/she is much more likely to feel like a contributor to society rather than a recipient of state benefit. The latest decision by NICE will make a working career impossible to sustain for many people, says the Arthritis and Musculoskeletal Alliance.

Ros Meek, Director, Arthritis and Rheumatism Musculoskeletal Alliance said “When the focus of the Government is to help people to remain in work and to encourage people off incapacity benefit and back into work, this decision is outrageous. These drugs are not all the same and their delivery also differs – some are offered as injections that can be self administered, some are given as infusions which take place in hospital. Individuals tolerance to the drugs can change over time too and it can’t always be predicted over the timescale that the person is likely to be on the therapy.”

These treatments have similar costs. Once the PCT has agreed to finance the cost for a patient, switching to another one has a negligible impact on their budget. The Arthritis and Musculoskeletal Alliance describes this latest decision as “incomprehensible”.

Arthritis and Musculoskeletal Alliance
www.arma.uk.net

Written by – Christian Nordqvist