title: Access to the next wave of biologic therapies (Abatacept and Tocilizumab) for the treatment of rheumatoid arthritis in England and Wales: addressing treatment outside the current NICE guidance.
abstract: Patients in England and Wales with rheumatoid arthritis (RA) receive treatment from the National Health Service (NHS) with therapies approved by the European Medicines Agency (EMA), under guidance from the National Institute for Health and Clinical Excellence (NICE). This document overviews the current NICE guidelines for the treatment of RA and identifies scenarios when such guidance may not represent the optimum management strategy for individual patients. Specifically, we consider the use of tocilizumab or abatacept as the most appropriate treatments for some patients. In such scenarios, it may be possible for the clinician to secure access to the required therapy through an application procedure known as an 'individual funding request', the process of which is described in detail here. At present, it is unclear the extent to which the proposed reform of the NHS will affect the role of NICE in providing guidance and setting standards of care. Until the full impact of the proposed changes are realized, individual funding requests will remain a valuable way of securing the optimal treatment for all patients suffering from RA.
authors.affiliation: Department of Rheumatology, Wirral University Teaching Hospital, Wirral, UK. yee.chiu@liverpool.ac.uk
authors.forename: Yee
authors.initials: Y
authors.lastname: Chiu
authors.forename: Andrew J K
authors.initials: AJ
authors.lastname: Ostor
authors.forename: Anthony
authors.initials: A
authors.lastname: Hammond
authors.forename: Katharina
authors.initials: K
authors.lastname: Sokoll
authors.forename: Marina
authors.initials: M
authors.lastname: Anderson
authors.forename: Maya
authors.initials: M
authors.lastname: Buch
authors.forename: Michael R
authors.initials: MR
authors.lastname: Ehrenstein
authors.forename: Patrick
authors.initials: P
authors.lastname: Gordon
authors.forename: Sophia
authors.initials: S
authors.lastname: Steer
authors.forename: Ian N
authors.initials: IN
authors.lastname: Bruce
mesh_terms: D000069594:Abatacept; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000628:therapy*; D003362:Cost-Benefit Analysis; D003657:Decision Making; D004739:England; D017408:Guidelines as Topic; D017048:Health Care Costs; D006297:Health Services Accessibility; D006801:Humans; D018796:Immunoconjugates / Q000627:therapeutic use*; D009313:National Health Programs; D017063:Outcome Assessment, Health Care; D012219:Rheumatology / Q000379:methods*; D016896:Treatment Outcome; D014852:Wales
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D018796:Immunoconjugates; D000069594:Abatacept; C502936:tocilizumab