Infliximab (Inflectra, Remicade and Remsima), adalimumab (Humira) and golimumab are now recommended as options for treating moderately to severely active ulcerative colitis in adults who have responded inadequately or have a contraindication or intolerance to conventional therapy including corticosteroids and mercaptopurine or azathioprine. Previous guidance restricted the use of these newer biologic therapies to patients hospitalised with severe ulcerative colitis.
NICE technology appraisal TA329
Infliximab is also now recommended as an option for treating severely active ulcerative colitis in children and young people aged 6–17 years with an inadequate response, contraindication or intolerance to conventional therapy including corticosteroids and mercaptopurine or azathioprine. Previously, access was limited to children with acute severe ulcerative colitis as an alternative to ciclosporin, and in Scotland only.
Infliximab and adalimumab are already recommended by NICE as potential options for adults with severe active Crohn's disease in whom conventional therapy has failed or is either contraindicated or not tolerated.
Treatment with infliximab, adalimumab or golimumab should only be continued for longer than 12 months if there is clear evidence of response (as determined by clinical symptoms, biological markers and investigations) and should be reassessed at least every 12 months. Trial withdrawal should be considered for all patients who are in stable clinical remission.
The choice of treatment between infliximab, adalimumab or golimumab should be made on an individual basis, taking into account therapeutic need and the likelihood of adherence.
The recommendation for golimumab is contingent on the company supplying the 100mg dose at the same cost as the 50mg dose, as agreed in the patient access scheme.