Outcry at British drug watchdog's plan to cut arthritis treatments

Tens of thousands of arthritis sufferers will be denied powerful drugs on the NHS under a controversial decision by the Government's rationing body

Patients' groups have reacted angrily to new guidelines which will mean 40,000 people with rheumatoid arthritis will have possible treatments withdrawn. Without the drugs the patients will suffer more pain, the possibility of more surgery and long-term disability, it is claimed. The decision amounted to a "prescription for pain", experts warned.

The National Institute for Health and Clinical Excellence (Nice), today issues a final appraisal document - the last draft before definitive guidance is issued - stating that patients who do not respond to one powerful drug cannot try another of the same type. Currently doctors are able to try patients on three variants of a drug type which work by blocking the action of a chemical. If one does not work or its effectiveness wears out over time, sufferers can switch to another, prolonging the period they can remain fit and active. But the drugs are very expensive, with even the cheapest costing around $200 a week per patient.

Many rheumatoid arthritis patients live with the disease for decades. They argue that cutting down the options will leave them needlessly living in agony for years. Cutting access to the drugs will speed their decline, meaning they are less able to work for a living and will have to rely more on benefits and care, campaigners say. Ailsa Bosworth, Chief Executive of the National Rheumatoid Arthritis Society, said: "This decision is another nail in the coffin for the treatment of rheumatoid arthritis in England and Wales. "Nice is re-writing the rules of rheumatoid arthritis treatment in this country ignoring the clinical effectiveness of drugs and ignoring the views of patients and clinicians."

Rheumatoid arthritis, which differs from osteoarthritis, is an auto-immune disease in which a person's joints are attacked by their body's own defences. It affects 400,000 people of all ages in the UK. Most suffer with a mild form that can be controlled with ordinary painkillers. However, tens of thousands needed the stronger drugs, called anti-TNFs as they block the action of a chemical called tumour necrosis factor (TNF). Between 20,000 and 40,000 people in England and Wales are taking an anti-TNF at any time, and 50 per cent have needed to switch treatments at least once. The anti-TNF drugs currently available on the NHS are Enbrel (its generic name being etanercept), Humira (adalimumab) and Remicade (infliximab).

Scientists are not sure why one anti-TNF drug might stop working over time but doctors and patients agree being able to switch between them can be highly beneficial. Once arthritis patients have exhausted the anti-TNF options, under NHS rules they can move on to another drug called rituximab, a 'biologic' which works by modifying the immune system. Until recently they would have then been able to try a separate drug called abatacept, but in April Nice quashed that option, saying it was not cost effective. Consequently campaigners say Nice has reduced the treatment options for people with the disease from five to two.

Professor Rob Moots, Professor of Rheumatology at Liverpool University, said: "It's almost impossible to know which anti-TNF will work for a patient at the outset. Before this decision we could try patients on each of the three treatments in turn to find one that was effective for them - now we only have one shot at success. "This flies in the face of clinical judgment. Many patients will be left in astonishing pain, while knowing we haven't explored all the options for them."

Ros Meek, Director of the Arthritis and Musculoskeletal Alliance, added: "Rheumatoid arthritis is a debilitating disease and living with it is an extremely painful experience. Nice's decision takes away access to a normal and independent life for the many thousands of people battling with the condition. It also totally contradicts Lord Darzi's pronouncements in his recent review of the NHS - in particular his focus on patient choice and patient empowerment. It's a prescription for pain."

A spokesman for Nice said: "Having taken all the available evidence of clinical and cost effectiveness into consideration, together with the views of patients and clinicians, the independent Appraisal Committee was not persuaded that TNF -? inhibitors, when used after the failure of a previous TNF - inhibitor, would be an appropriate use of NHS resources. "However, the Committee agreed on the importance of further research that examines the comparative effectiveness of all possible options for treating people with Rheumatoid Arthritis". "People currently receiving adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis after the failure of a previous TNF -alpha inhibitor should have the option to continue therapy until they and their clinician consider it appropriate to stop."

Nice's final guidance is expected in September but campaigners hope their appeals will lead to a last minute U-turn. In April, following public outcry, Nice changed its prescription guidance for Lucentis, a drug which slows down onset of the severe eye condition macular degeneration. And in May the Court of Appeal ruled that Nice must explain how it reaches its decisions on whether or not to recommend drugs, in an ongoing battle over the Alzheimer's treatment Aricept. However, it has never lost a case regarding its guidance in court.

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