In June 2010 the National Institute for Health and Clinical Excellence (NICE) issued an update on the use of biologic agents. It has taken advice from specialists and reversed previous judgements on the use of abatacept and tocilizumab. These may now be used after the failure of TNF blockade in patients who have had a reaction to rituximab or where this is contraindicated. A previous ruling added certolizumab pegol to the list of TNF blockers. Goliliumab is now also approved for use in psoriatic arthritis.
NICE conceded that failure to respond to one biologic does not preclude response to another.
While the new guidance does not give rheumatologists a free rein in prescribing it does widen the choice of biologics, and also acknowledges that there is poor cause to treat all of them as equivalent. We have always argued that TNF antibodies (the drugs ending in "ab" may work in a slightly different way to receptor blockers (whose names end in "cept"), and also that there is no reason to suppose that B-cell or T-cell inhibition (rituximab and abatacept) and interleukin-6 antagonism (tocilizumab) work in an identical way.
Rheumatologists facing those patients who had previously run out of options can rejoice!
Revised 21st May 2011
To see our poster "New: follow-up ratios: Dogma or Design" presented at Rheumatology 2011 (poster 59) click here. For a previous presentation "Impact of a community-based rheumatology service on a hospital department" (Bamji & Lane, Rheumatology 2010, poster 96, 21st April 2010) click here
Added 21st May 2011
BBC's Timewatch programme, broadcast on Saturday November 1st 2008, BBC2) was about the last days of the First World War and will be introduced by Michael Palin. Dr Bamji, who is Curator of the Queen Mary's Hospital Archives, discussed the issues of injury and disfigurement, ensuring that our memories of the 90th anniversary of the end of the war will not be confined to remembrance of those who died.
Added 14th November 2008
This BBC Radio 4 series, introduced by Dr Mark Porter, keeps listeners up to date with modern practice and gives them an insight into the workings of professionals. Mark and producer Paula McGrath interviewed Dr Bamji and physiotherapist Julie Abrahams in March 2009 at Erith Hospital and listened in to some patient consultations. Click here to listen
Dr Bamji with producer Paula McGrath and Mark Porter
Page last updated 21st May 2011