Access to arthritis drugs denied

Around 60,000 people in the UK with rheumatoid arthritis (RA) are being denied access to potentially life-changing drugs - reports ITV News today.

A decision by the National institute for health and clinical excellence (NICE) will mean that patients will not able able to try a second anti-TNF (tumour necrosis factor alpha inhibitor) if their first attempt at the therapy fails.

Anti-TNF therapy drugs - adalimunab, etanercept, infliximab - can slow the progress of disease and help to reduce symptoms such as joint pain, swelling, mobility and fatigue.

NICE said that giving patients two, or even three, anti-TNFs is not 'cost-effective' and that doctors should offer patients the next drug in line - rituximab - which costs about £3,000 less per year than the cheapest anti-TNF.

This is yet another example of health services restricting effective drugs on the grounds of costs that, if provided, could greatly improve many people's quality of life. All the while the government shamefully continues to waste an astonishing £115m a week on the audit-failing European Union.

Charities have said that moving from one therapy to a second or third has been established practice in the UK for years and the change could leave sufferers with pain and the possibility of long-term disability.

Rob Moots, ARMA clinician and professor of rheumatology at Liverpool University, 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."

The British Society for Rheumatology Biologics Register shows that around 70% of patients will get a good response from a second anti-TNF if the effects of the first start to wane.

Ailsa Bosworth, chief executive of the National Rheumatoid Arthritis Society, said the move, combined with a Nice decision in April to reject the drug abatacept, meant effective therapies for arthrities provided by the NHS had been cut from five to two.

She added: "This decision is another nail in the coffin for the treatment of RA in England and Wales.

"Nice are re-writing the rules of RA treatment in this country, ignoring the clinical effectiveness of drugs and ignoring the views of patients and clinicians.

"Nice is systematically taking away clinically effective and proven treatments from patients and giving them just one roll of the dice when it comes to Anti-TNF treatment."

Ros Meek, director of the Arthritis and Musculoskeletal Alliance (ARMA), said: "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."

A spokeswoman for Nice said: "Nice has not yet issued final guidance to the NHS. Consultees now have the opportunity to appeal against the draft guidance. Subject to an appeal being received, guidance is expected in September 2008."

Pain relief drug ruled too costly for the NHS

Thousands of arthritis sufferers will be denied treatment with proven benefits by a decision not to pay for a new drug, reports The Times today.

In another example of how the extra £2.5bn a year that the government has unjustifiably pledged to the EU could be used to help those who need it most - rather than handed to an organisation that has failed its audit for twelve years in a row - the National Institute for Health and Clinical Excellence (NICE) is to recommend that the new drug Abtacept (Orencia) does not represent "value for money".

Yet the drug has been shown to improve dramatically the severest symptoms of arthritis in almost half of patients.

Its manufacturer, Bristol Myers Squibb, estimated in its application to NICE that around 3,500 patients a year would benefit. But other studies show that around 12,000 patients could potentially benefit.

Published data shows that in trials Abatacept produced a 50% reduction in symptoms in about 40% of the patients who used it in conjunction with an older drug, methotrexate.

Though the cost would be about £9,300 a year on average, all of those treated would be sufferers who had already been treated unsuccessfully with anti-TNF drugs, which are equally expensive.

Ailsa Bosworth, chief executive of the National Rheumatoid Arthritis Society said, “This is extremely bad news for people living with severe rheumatoid arthritis.

“Denying patients the option of Abatacept leaves some of them with the unacceptable choices of being put back on to treatments they have already failed on, palliative care or taking large doses of steroids, which have unacceptable side-effects over the long term.”

A NICE spokesman said: “Having examined cost-effectiveness analyses on the drug against a range of comparators, the committee concluded that Abatacept could not be considered a cost-effective use of NHS resources.”

The problems of balancing drug costs against benefits have led a growing number of patients who are denied treatments to resort to legal action.

Undoubtedly, any MPs who approve this blatant waste of public money by voting in favour of the European Communities (Finance) Bill when it comes before Parliament in the next session will forfeit any claim to be supporting the development of a modern, effective health service.