Etanercept – Rheumatoid arthritis – after other DMARDs including a TNF inhibitor – as per NICE TA 195 and local policy

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

September 2010: The TAG noted NICE TA 195: which states that adalimumab, etanercept, infliximab and abatacept, each in combination with methotrexate, are recommended as treatment options only for adults with severe active rheumatoid arthritis who have had an inadequate response to, or have an intolerance of, other DMARDs, including at least one TNF inhibitor, and who cannot receive rituximab therapy because they have a contraindication to rituximab, or when rituximab is withdrawn because of an adverse event.

Adalimumab monotherapy and etanercept

monotherapy are recommended as treatment options for adults with severe active rheumatoid arthritis who have had an inadequate response to, or have an intolerance of, other DMARDs, including at least one TNF inhibitor, and who cannot receive rituximab therapy because they have a contraindication to methotrexate, or when methotrexate is withdrawn because of an adverse event.

Treatment with adalimumab, etanercept, infliximab and abatacept should be continued only if there is an adequate response (as defined in the guidance) 6 months after initiation of therapy. Treatment should be monitored, with assessment of DAS28,at least every 6 months and continued only if an adequate response is maintained.

January 2011: The TAG noted NICE’s algorithm (November 2010) on biologic drugs for rheumatoid arthritis.

September 2018:

The TAG noted NICE NG 100 (July 2018) – Management of rheumatoid arthritis in adults, which included new and updated recommendations on:

*           investigations following diagnosis

* treat-to-target strategy and initial pharmacological management

* symptom control and monitoring

and also:

* investigations for diagnosis and referral from primary care

* non-pharmacological management and the multidisciplinary team

* communication and education

September 2018:

NICE NG 100 (July 2018) was noted by the N&W CCGs’ Drugs & Therapeutics Committee

September 2018:

The TAG noted and a revised Specialist Treatment Pathway for Rheumatoid Arthritis which had been updated with the most recent advice on adalimumab. The place of baricitinib was also clarified.

The TAG was advised that (biosimilar) adalimumab (once available) would remain as the CCGs’ preferred 1st line (biologic) treatment option; a JAK inhibitor would be considered only where biologics are contraindicated.

Any further comments from the Trusts regarding the order of use of NICE-recommended therapies within the pathway to be submitted to the CSU’s Specialist Interface Pharmacist.

The TAG otherwise agreed with the treatment pathway in principle.

September 2018:

The N&W Drugs & Therapeutics Committee (D&TC) noted and supported the TAG’s recommendations