Furthermore, NICE acceptance is contingent on the manufacturer, UCB Pharma, providing the first 12 weeks of treatment for free.
Certolizumab pegol can be used in adults who meet both of the following criteria:
- Active RA with disease activity score (DAS28) greater than 5.1 confirmed on at least two occasions, one month apart
- Previous trials of two DMARDs, including methotrexate (unless contraindicated). DMARD trials are usually for 6 months with 2 months at standard dose.
Patients on certolizumab pegol, adalimumab, etanercept or infliximab should normally receive methotrexate. If methotrexate is inappropriate or not tolerated, certolizumab, adalimumab and etanercept may be given as monotherapy.
Treatment should only be continued if there is an adequate response (DAS28 improvement of at least 1.2) 6 months after initiating therapy. Response should be monitored at least every 6 months and treatment should be discontinued if an adequate response is not maintained.
For patients who are intolerant of treatment before the initial 6-month assessment, prescribers should consider an alternative TNF inhibitor.
Treatment should normally be initiated with the least expensive drug, and escalation above the licensed starting dose is not recommended.
Treatment of severe, active and progressive RA is not recommended in adults who have not previously received methotrexate or other DMARDs.