By: 21 October 2015
NICE draft guidance recommends treatments for types of arthritis that affect the spine

NICE draft guidance recommends treatments for types of arthritis that affect the spine

In final draft guidance published, NICE has recommended adalimumab (Humira, AbbVie), etanercept (Enbrel, Pfizer), infliximab (Remicade, Merck Sharp & Dohme; Inflectra, Hospira; Remsima, Napp Pharmaceuticals)1, certolizumab pegol (Cimzia, UCB Pharma) and golimumab (Simponi, Merck Sharp & Dohme) 2 – known as TNF-alpha inhibitors – for treating some types of inflammatory arthritis that affect the spine.

As well as re-affirming previous NICE guidance recommending adalimumab, etanercept and golimumab as treatment options for adults with ankylosing spondylitis, the draft guidance also now recommends infliximab and certolizumab pegol as additional treatment options for adults with anklylosing spondylitis.

Non-radiographic axial spondyloarthritis is also covered by the draft guidance and adalimumab, certolizumab pegol and etanercept are provisionally recommended as treatment options for adults with this condition.

Ankylosing spondylitis and axial spondyloarthritis are part of a group of inflammatory rheumatologic diseases known as spondyloarthritis. They cause inflammation mainly in the lower spine, which results in back pain and stiffness. Inflammation at the sites where ligaments and tendons attach to bone can lead to new bone development and joint fixation (ankylosis), where joints and bones fuse together.

Disease is classified as ankylosing spondylitis if changes to the sacroiliac joints4 or the spine, or both, can be seen on X-ray. Where there is no X‑ray evidence of the disease, it is classified as non-radiographic axial spondyloarthritis.

Professor Carole Longson, Health Technology Evaluation Centre Director at NICE, said: “Both these conditions are irreversible and can cause a great deal of pain and discomfort and have a significant negative impact on quality of life.

“We are therefore pleased to be able to recommend for the first time, treatment options for adults with non-radiographic axial spondyloarthritis, as well as add infliximab and certolizumab pegol to the list of clinically and cost effective treatment options for adults with ankylosing spondylitis.

“At its meeting to consider responses to the consultation on the first draft of the guidance the Comiittee heard from patient experts who highlighted that not being able to try a second TNF-alpha inbibitor would leave people reliant either on NSAIDs which had already proved inadequate to control symptoms, and are associated with long-term adverse effects, or to continue on their sub-optimal TNF-alpha inhibitor indefinitely. The Committee acknowledged that predicting how the condition would respond to an initial TNF-alpha inhibitor was not possible, and that this could have a major impact on a lifelong condition. The Committee therefore agreed there was a clinical need to be able to consider further TNF-alpha inhibitor treatments as options and this is now recommended in the draft guidance.”

This is draft guidance – NICE has not yet issued final guidance to the NHS. The draft guidance is now with consultees, who have the opportunity to appeal against it. Once NICE issues its final guidance on a technology, it replaces local recommendations across the country.