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NICE rejects Otezla for psoriatic arthritis coverage

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After issuing guidance on the use of a number of biologic therapies for rheumatoid arthritis today, the National Institute for Heath and Care Excellence has turned down Otezla for coverage under the health care system in the U.K. for psoriatic arthritis, citing concerns about cost-effectiveness, according to documents published by the organization.

The National Institute for Heath and Care Excellence (NICE) Appraisal Committee wrote that Otezla (apremilast, Celgene) is less cost-effective than Enbrel (etanercept, Amgen) or Humira (adalimumab, AbbVie) and resulted in fewer quality-adjusted life-years (QALYs) than its competing tumor necrosis factor-alpha (TNF-a) inhibitors.

The committee wrote TNF-a inhibitors are estimated to result in an incremental cost-effectiveness ratio (ICER) of £18,997 per QALY gained compared with apremilast, which is estimated to produce an ICER of £23,487. The committee further wrote that apremilast should not be used prior to treatment attempts with TNF-a inhibitors due to greater costs than TNF-a inhibitors in models the committee studied.

“[The committee] heard from clinical and patient experts that apremilast may provide an additional treatment option for patients, due to its different mode of action and oral formulation,” the members wrote. “However, given its previous conclusion on clinical efficacy ... the committee considered that apremilast was not a step change in treatment. The committee concluded that there were no additional gains in health-related quality of life over those already included in the QALY calculations, and that there was no need to change its conclusions on that basis.”

In a separate document, the committee recommended the use of adalimumab and etanercept to treat severe rheumatoid arthritis (RA), along with Remicade (infliximab, Janssen), Cimzia (certolizumab pegol, UCB) Simponi (golimumab, Janssen), Actemra (tocilizumab, Genentech) and Orencia (abatacept, Bristol-Meyers Squibb) in addition to methotrexate and under certain conditions. The disease activity in 28 joints (DAS28) must be greater than 5.1, nonresponsive to other “intensive” treatment with disease-modifying anti-rheumatic drugs (DMARDs) and that the respective drug manufacturers abide by agreements related to discounted drug costs, according to the document. Treatment is recommended by the committee for withdrawal after 6 months if an appropriate response is not achieved.

Reference: www.nice.org.uk.