Medicines

Here you will find the recommendations we have made about the use of individual medicines in Lancashire.

Tofacitinib

Brand: Xeljanz®
NICE TA: 480
Indication: Moderate to severe rheumatoid arthritis (NICE TA480)
Disease category: Musculoskeletal system
Commissioning responsibility: CCG
PbR excluded: No

Background

Tofacitinib, with methotrexate, is recommended as an option for treating active rheumatoid arthritis in adults whose disease has responded inadequately to intensive therapy with a combination of conventional disease-modifying anti-rheumatic drugs (DMARDs), only if:

•disease is severe (a disease activity score [DAS28] of more than 5.1) and
•the company provides tofacitinib with the discount agreed in the patient access scheme.

Tofacitinib, with methotrexate, is recommended as an option for treating active rheumatoid arthritis in adults whose disease has responded inadequately to, or who cannot have, other DMARDs, including at least 1 biological DMARD, only if:

•disease is severe (a DAS28 of more than 5.1) and
•they cannot have rituximab and
•the company provides tofacitinib with the discount agreed in the patient access scheme.

Tofacitinib can be used as monotherapy for adults who cannot take methotrexate because it is contraindicated or because of intolerance, when the criteria in sections 1.1 and 1.2 are met.

Continue treatment only if there is a moderate response measured using European League Against Rheumatism (EULAR) criteria at 6 months after starting therapy. After an initial response within 6 months, withdraw treatment if at least a moderate EULAR response is not maintained.

These recommendations are not intended to affect treatment with tofacitinib that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

Decisions of Lancashire local decision making groups:

NHS Blackburn With Darwen CCG and NHS East Lancashire CCG NHS Blackpool CCG NHS Chorley and South Ribble CCG and NHS Greater Preston CCG NHS Fylde and Wyre CCG NHS Morecambe Bay CCG NHS West Lancashire CCG

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