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NICE recommends tocilizumab for rheumatoid arthritis


In February, NICE published guidance recommending tocilizumab (also known as RoActemra, manufactured by Roche) at an earlier stage in treating rheumatoid arthritis. The new guidance is a rapid review of the 2010 guidance


(TA198) following a new patient access scheme which the manufacturer has agreed with the Department of Health. The guidance sets out that in specific clinical circumstances, and only if the manufacturer provides tocilizumab at the agreed discounted price, tocilizumab is also now recommended alongside other options for treating rheumatoid arthritis at an earlier point in the treatment pathway. Professor Carole Longson, Director of the Health Technology


Evaluation Centre at NICE, said: “Rheumatoid arthritis can have a huge impact on quality of life and for many it’s a disabling condition, so we’re pleased to recommend tocilizumab at an additional stage in treating the condition. “The new guidance recommends tocilizumab alongside other


treatment options after treatment with conventional drugs – DMARDS – has failed. We have already recommended the TNF inhibitors adalimumab, etanercept, infliximab, certolizumab pegol and golimumab for some people with rheumatoid arthritis as options for use at this stage; tocilizumab is now added as another option alongside these treatments.” www.nice.org.uk/TA247


Prolonged release exenatide for type 2 diabetes


In February 2012, NICE published guidance recommending prolonged release exenatide (also known as Bydureon) in triple therapy regimens (in combination with metformin and a sulphonylurea, or metformin and a thiazolidinedione) as a treatment option for people with type 2 diabetes, when control of blood glucose remains or becomes inadequate (HbA1c of 7.5% or above, or other higher level agreed with the individual), and the person has: a BMI of 35 kg/m2 or higher in those of European family origin (with appropriate adjustment for other ethnic groups) and specific psychological or medical problems associated with high body weight, or a BMI below 35 kg/m2, and therapy with insulin would have significant occupational


(in combination with metformin or a sulphonylurea) is recommended as a treatment option in people with type 2 diabetes, only if: the person is intolerant of either metformin or a sulphonylurea, or treatment with metformin or a sulphonylurea is contraindicated, and the person is intolerant of thiazolidinediones and dipeptidyl peptidase-4 (DPP-4) inhibitors, or treatment with thiazolidinediones and DPP-4 inhibitors is contraindicated. Again, treatment with


implications or weight loss would benefit other significant obesity-related comorbidities. Treatment with prolonged- release exenatide in a triple


therapy regimen should only be continued if a beneficial metabolic response has been shown. Prolonged-release exenatide in dual therapy regimens


prolonged-release exenatide in a dual therapy regimen should only be continued if a beneficial metabolic response has been shown. www.nice.org.uk/guidance/ TA248


www.nursinginpractice.com


Nursing in Practice March/April 2012 9


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