Etanercept (Enbrel® / Benepali® ▼) – Idiopathic juvenile arthritis – polyarticular, psoriatic and enthesitis-related JIA as per NICE TA 373 and NHS England policy

NICE recommendations, summary of meeting discussions, links to additional supporting docs etc.

March 2002 NICE:

Etanercept is recommended for children aged 4 to 17 years with active polyarticular-course juvenile idiopathic arthritis whose condition has not responded adequately to, or who have proved intolerant of, methotrexate. Etanercept should be prescribed in accordance with relevant sections of the British Paediatric Rheumatology Group (BPRG) protocol.

September 2015:  The TAG noted E03/P/d (E03X04) (July 2015) (NHS England commissioning policy) and recommended a traffic light classification of Red (Specialist use only) for this SCG-commissioning responsibility treatment.

Treatment of Juvenile Idiopathic Arthritis (JIA):

Anti-TNFs may be used 1st line only in:

* Patients with Axial disease or sacroiliitis (see Appendix A). This is accepted and NICE-approved practice in adults with Spondyloarthropathy.

* Patients with Systemic-Onset JIA who show signs of Macrophage Activation Syndrome (MAS).

Biologic therapies:

(Biologics should not be used unless a patient is intolerant to, or has failed optimised treatment with MTX (defined as 15mg/m2 given subcutaneously once-weekly for at least 3 months; higher doses have no evidence to suggest increased efficacy)).

The TAG also recommended that the pathway for treatment of children with JIA Appendix A be applied to the treatment of rising young adults with JIA (CCG-commissioning responsibility).

October 2015:

Noted by the Norfolk & Waveney CCGs’ Drugs & Therapeutics Commissioning Group (D&TCG).

The committee also considered what treatment pathway is followed for patients >18 years and agreed that the suggested pathway for children should be considered locally for young adults with JIA.

November 2015:  The TAG recommended that CCGs should adopt the NHS England treatment pathway for JIA in children as a whole to cover the commissioning responsibility for care of young adults >18 years with JIA.  The treatments in the pathway are recommended as Red (Hospital / Specialist use only) for this indication.

November 2015:  The NHS Norfolk & Waveney CCGs’ noted and supported the TAG recommendation.

January 2016:  The TAG noted NICE TA 373 which replaces NICE TA 35 (2002)  which recommends use of Abatacept (Orencia®), adalimumab (Humira®), etanercept (Enbrel®) and tocilizumab (RoActemra®) as possible treatments for children and young people with polyarticular juvenile idiopathic arthritis.

Adalimumab and etanercept are recommended as options for enthesitis-related juvenile idiopathic arthritis.

Etanercept is recommended as a possible option for psoriatic juvenile idiopathic arthritis.

The TAG noted that NICE TA 373 (December) differed from NHS England’s interim policy (July 2015) regarding the clinical conditions covered and the recommended treatments and recommended waiting until NHS England published its final policy document post NICE TA 373 before making any changes to what is commissioned locally.

January 2016:  The NHS Norfolk & Waveney CCGs’ D&TCG noted NICE TA 373 and the TAG’s recommendation.