ARMA's statement on NICE's decision on switching Anti-TNF for RA

Published: 07/18

LONDON, UK - (HealthTech Wire) - Thousands of rheumatoid arthritis (RA) patients have today (21 July) been denied effective NHS treatments on the basis of cost. The move – by the National Institute for Health and Clinical Excellence (NICE) – withdraws currently available treatment options and has been branded ‘a prescription for pain’ by the Arthritis and Musculoskeletal Alliance (ARMA).

The NICE appraisal document on sequential treatment for rheumatoid arthritis published today prevents the NHS patients from trying a different anti-TNF treatment to control their RA if the first has been unsuccessful.

Anti-TNFs are prescribed for patients with active or severe RA and rheumatologists can choose between three treatments. At the moment it is common practice for rheumatologists to switch a patient to another anti-TNF if the first or previous treatment is poorly tolerated or lacks effectiveness for that individual patient. Between 20,000 and 40,000 people in England and Wales are taking an anti-TNF at any time, and 50% have needed to switch treatments at least once.

Professor Rob Moots, ARMA clinician and Professor of Rheumatology at the University of Liverpool, said: “It’s almost impossible to know which anti-TNF will work for a patient at the outset. Before this decision we could try patients on each of the three treatments in turn to find one that was effective for them – now we only have one shot at success.

“This flies in the face of clinical judgment. Many patients will be left in astonishing pain, while knowing we haven’t explored all the options for them.”

Rheumatoid arthritis is a chronic and progressive immune disease that affects around 400,000 people in the UK. The disease typically develops in a person’s 30s or 40s, but can happen at any age, including babies and children.

Rheumatoid arthritis results in extreme pain and swelling of the affected joints. As the disease progresses, it leads to the destruction of the joints, causing severe disability. It prevents people from carrying out everyday tasks and many people have to give up work.

Ros Meek, Director of ARMA said: “Rheumatoid arthritis is a debilitating disease and living with it is an extremely painful experience. NICE’s decision takes away access to a normal and independent life for the many thousands of people battling with the condition. It also totally contradicts Lord Darzi’s pronouncements in his recent review of the NHS - in particular his focus on patient choice and patient empowerment.  It’s a prescription for pain.”

There is no cure for RA, but anti-TNFs can slow and sometimes even halt the progression of the disease, effectively freezing it in its tracks, while also controlling the pain it causes.

Today’s decision comes despite NICE acknowledging that each of the treatments is individually clinically- and cost-effective. The only way patients will be able to try more than one anti-TNF now is by entering into a clinical trial. At best this would only help a tiny fraction of the patients who could otherwise benefit.

ARMA will appeal against today’s decision.