NICE has published new recommendations on the use of biologics in rheumatoid arthritis (RA) replacing previous guidance on adalimumab, etanercept, infliximab, certolizumab pegol, golimumab (for methotrexate-naive RA) and abatacept (after the failure of DMARDs).
There have also been partial updates to guidance on the use of tocilizumab , and on the use of golimumab after failure of DMARDs .
All seven biologics can now be prescribed on the NHS when:
- there is severe RA with a disease activity score (DAS28) of more than 5.1
- there has been a lack of response to intensive therapy with a combination of conventional DMARDs
- the manufacturers provide certolizumab pegol, golimumab, abatacept and tocilizumab as agreed in the patient access schemes.
Like adalimumab, etanercept and certolizumab pegol, tocilizumab can now be used as monotherapy when use of methotrexate is contraindicated or when a patient is intolerant.
NICE still recommends that treatment be withdrawn if a moderate response (according to EULAR criteria) is not maintained at 6-monthly reviews.