The content of this article is personal opinion and all facts are taken from the NICE guidance unless otherwise stated, all of the references are at the bottom of this blog article, feel free to check them. If you believe I have misrepresented the facts, simply let me know via the contact page and I will review. This post is for entertainment purposes only, this is not advice.
To star crossed lovers….
O.k so maybe this is a little less romantic, but it certainly is as interesting… if your into Biologics.
November was a busy time for NICE: the people who say yes or no to new drugs for the NHS.
So the drama plays out. Two new Biologics: Cimzia and Ilumetri.
Only one makes it through the NICE assessment to be prescribable in England and Wales.
And the loser is….
Ilumetri (at least for now)
Whilst the published report is excessively boring I did chuckle at the subheading ‘Tildrakizumab is not innovative’. Tildrakizumab is of course another of the complex drug names that are so commonly used for biologics. We will stick with the more
The thing is, this drug did actually work, in trials it showed improvements when compared to etanercept and placebo (something that looks like the drug but has no active drug in it). You remember that time you gave your kid brother a lemonade and told him it was vodka? it’s to stop people from experiencing the results they expect. My brother was the most drunk sober person I have ever seen!
Like most things- calculations come down to costs vs benefits. In the case of Ilumetri, other biologics already in use in the NHS were more effective and cost less. The exception is Infliximab, which is licensed for use only for very severe psoriasis (1).
Some of us will find this frustrating, particularly if you are one of the people who has zoomed through all of the biologics so far and would feel much happier having more drugs on the horizon. There will be a review in 3 years time (and there are several more biologics which are on their way out into the market so do not despair).
This little beauty has passed stage one recommendation for authorisation: the second committee meeting is set for January 22nd 2019.
Cimzia (Certolizumab pergol) has been licensed for use for moderate to severe psoriasis (yay!) but before you start rejoicing the usual rules apply.
You need to have a PASI score of 10 or more (don’t know what a PASI is? I wrote this article that explains it) and a DLQI score of more than 10. DLQI stands for Dermatology Life Quality Index and basically measures how much Psoriasis p****s you off and impacts your life.
You also need to have failed at the systemic treatments cyclosporin and methotrexate.
Also unsurprisingly, Cimzia is more effective than these systemic treatments. It is not prescribed first though due to cost considerations, which is a fair point with methotrexate coming around £1.51 for a 24 pack of 2.5mg tablets, it’s going to be hard to compete on price. The minimum dose licence is 200mg which comes in at £357.50 per pre-filled syringe (2,3). Some doctors also prefer to prescribe treatments with a long-standing safety profile first as the drug reactions are more easily predicted –although the BADBIR is collecting huge amounts of data on the safety of biologics (in my opinion they are much safer than you think).
The cost of Cimzia is similar to other equivalent biologics at the lowest dose. It is not cost effective at a higher dose.
So what do you think? Have you already tried Cimzia? If you want more content like this just let me know in the comments 🙂
If you want to read the documents issued by NICE, be my guest 🙂
1. Ilumetri: https://www.nice.org.uk/guidance/GID-TA10191/documents/appraisal-consultation-document
2. Cimzia: https://www.nice.org.uk/guidance/GID-TA10240/documents/appraisal-consultation-document
3. Methotrexate drug costs
Data used refers to the cost from Alliance healthcare and is excluding VAT. You can see more here: https://bnf.nice.org.uk/medicinal-forms/methotrexate.html