NICE has published technology appraisals for two biologics used in the treatment of musculoskeletal inflammatory disease.
Golimumab (Simponi) is now recommended as an option for the treatment of severe, active ankylosing spondylitis (AS) in adults with all of the following:
- Disease that satisfies the modified New York criteria for diagnosis of AS
- Confirmation of sustained active spinal disease on two occasions at least 12 weeks apart without any change in treatment (score of at least 4 units on the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and at least 4cm on the spinal pain Visual Analogue Scale (VAS)
- Treatment with two or more NSAIDs taken sequentially for 4 weeks has failed.
The manufacturer must provide the 100mg dose of golimumab, needed in people who weigh more than 100kg, at the same cost as the 50mg dose.
Treatment response should be assessed every 12 weeks. If an adequate response (defined as a reduction of BASDAI to 50% of the pre-treatment value or by at least 2 units, and a reduction in VAS by 2cm or more) is not maintained, the response should be reassessed after a further six weeks and discontinued if it remains inadequate.
Abatacept (Orencia), in combination with methotrexate, is not recommended for the treatment of moderate to severe active rheumatoid arthritis when one or more conventional DMARDs, including methotrexate, has failed.