Friday, 30 September 2016

NewsSpeak & PoliticalSpeak: NICED twice in one week

NICE turns down daclizumab for MSers on the NHS. #NewsSpeak #PoliticalSpeak #MSBlog

NICE have just published their appraisal consultation document for daclizumab and have not recommended it on the NHS within its marketing authorisation for treating relapsing forms of multiple sclerosis in adults. This is depressing news and is not in the interests of MSers in England. I would not have expected daclizumab to be widely prescribed, but there is definitely an unmet need for its use in a well-defined cohort of patients. As I have said many times before daclizumab is not overtly immunosuppressive and therefore is an ideal switching drug for patients at high risk of PML on natalizumab. There are also a significant number of patients with highly-active disease, who have failed platform therapies, in whom fingolimod is contraindicated, who would benefit from daclizumab. These patients will now have little option, but to be treated with alemtuzumab. What about alemtuzumab failures? If NHS England don't allow us to give third and fourth courses of alemtuzumab this will be a relatively large population of patients. I have even argued in the past that patients with highly active disease or rapidly evolving severe MS who are JCV-positive may choose daclizumab over alemtuzumab first-line. Daclizumab has some attributes that will make it more appealing to some patients than alemtuzumab, i.e. it is self-administered and is not immunosuppressive. 

What now? I sincerely hope Biogen and Abbvie appeal this decision and that we the wider MS community let NICE know that we disagree with their assessment. At the end of the day having choice makes implementing personalised medicine in MS more a reality. Not being able to prescribe one of the licensed MS therapies simply disadvantages people with MS living in England. The cynic in me, however, thinks that NICE is simply asking for a big discount in the price of daclizumab for the NHS, relative to its listed price. This 'game of cat-and-mouse' is well tried and tested and is one of the reasons why the NHS gets high-cost drugs cheaper than other developed countries and why most other countries are putting in place their own versions of NICE.


CoI: multiple

1 comment:

  1. I do hope there will be an appeal against this decision and daclizumab will be eventually considered as a treatment option. If my understanding is correct it is a very effective drug (similar to fingolimod) but is safer than many DMTs as it has fewer side effects.

    The new technology of DMTs is going towards the direction of having a safer profile with high efficiency and it will be a shame if such drugs are not licensed.

    It is a shame that the European Medicines Agency has given the green light, but NICE chose to turn it down. :(

    ReplyDelete

Please note that all comments are moderated and any personal or marketing-related submissions will not be shown.