NICE Draft guidance

The National Institute for Health and Clinical Excellence (NICE) had previously recommended the medication, but said new evidence had come to light about its effectiveness as a second-line treatment option and there were doubts about its value for money. The announcement follows a decision earlier this week to approve golimumab as a treatment option for rheumatoid arthritis.

The draft guidance from NICE rejects the use of abatacept (marketed by Bristol-Myers Squibb under the brand name Orencia) in combination with methotrexate for treating rheumatoid arthritis in adults whose disease has responded inadequately to other medication.

It says patients currently receiving abatacept for treating rheumatoid arthritis should be allowed to continue therapy until they and their clinicians consider it appropriate to stop.


Arthritis Care described the decision as “disappointing“. Federico Moscogiuri, head of policy and campaigns, said in a statement: “This decision is very disappointing as it limits choice for people with severe rheumatoid arthritis.

‘Drugs currently available for treating rheumatoid arthritis simply do not work for everyone. For those most affected by this disease, having access to the widest range of treatment options will give them the best chance of stopping this potentially disabling condition in its tracks.”

Arthritis Care said NICE’s latest decision appeared to be inconsistent with guidance issued last year which recommended abatacept in circumstances where some other treatments had failed.

Dr Carole Longson, Health Technology Evaluation Centre Director at NICE accepted that an approval recommendation had previously been issued, but added in a statement that ” the Appraisal Committee concluded that using abatacept as a second-line treatment option was not supported by the evidence provided”.

Longson continued that “the manufacturer of abatacept had noted that their product would not be cost-effective for second-line use when compared to a range of alternatives including adalimumab, etanercept and certolizumab pegol”.




On Wednesday, NICE approved another medication for the treatment of rheumatoid arthritis. In final guidance it said golimumab (Simponi) could be prescribed for adults in combination with methotrexate where the condition had not responded adequately to conventional anti-rheumatic medication.

A number of conditions have to be met before golimumab can be offered, including that manufacturer, Schering-Plough, provides the 100 mg dose at the same cost as the 50 mg dose.

Longson says: “This final guidance sets out the circumstances where golimumab can now be offered by the NHS as a treatment option for people with rheumatoid arthritis for whom previous treatments have not worked. Rheumatoid arthritis treatments help to relieve pain, improve mobility and reduce the long-term damage often experienced by people with this condition.

“NICE has already recommended seven treatment options for patients living with this very disabling disease; now golimumab is another option.”

Arthritis Care described NICE’s decision to recommend golimumab as “terrific”.


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