NICE released new recommendations for RA Treatment

The drugs rituximab, adalimumab, etanercept, infliximab, and abatacept were recommended, in certain circumstances, as possible treatments for RA when treatment with a tumor necrosis factor inhibitor has failed. Additionally, NICE recommends tocilizumab as an option for RA treatment.

The guidance states:

- Rituximab (MabThera) in combination with methotrexate, is recommended as an option for the treatment of adults with severe active rheumatoid arthritis that has responded inadequately to other disease-modifying anti-rheumatic drugs (DMARDs. Treatment should not be given more frequently than every six months and should only be continued if there is an adequate response.

- Adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade) and abatacept (Orencia), each in combination with methotrexate are recommended for the treatment of people with severe active rheumatoid arthritis that has responded inadequately to other DMARDs, or who are intolerant of other DMARDs, and where people cannot take rituximab because rituximab is contraindicated, or when rituximab is withdrawn because of an adverse event. Treatment with the drugs should be continued only if there is an adequate response six months after the start of therapy.

- Adalimumab monotherapy (where the drug is given without methotrexate) and etanercept monotherapy are recommended in the circumstances outlined above but where people cannot take rituximab because methotrexate is contraindicated, or methotrexate is withdrawn because of an adverse event.

- Tocilizumab (RoActemra), in combination with methotrexate, is recommended for the treatment of rheumatoid arthritis in people whose rheumatoid arthritis has responded inadequately to one or more TNF inhibitors and whose rheumatoid arthritis has responded inadequately to rituximab or in whom rituximab is contraindicated or when rituximab is withdrawn because of an adverse effect.