NICE recommends two new treatments for inflammatory arthritis

NICE has recommended two new treatments for axial spondyloarthritis, an underdiagnosed and debilitating type of inflammatory arthritis.

Ixekizumab (also known as Taltz and made by Eli Lilly) and secukinumab (also known as Cosentyx and made by Novartis) have been recommended as treatments for people whose disease has not responded sufficiently to conventional therapies.

Spondyloarthritis occurs when the body's immune system starts to cause inflammation in the joints and the area around them, causing damage. Axial spondyloarthritis mainly causes pain and stiffness in the back, but it can also affect other joints in the body.

Clinical trial evidence demonstrated that ixekizumab and secukinumab are more effective compared with a placebo. However, due to uncertainties about the drugs, they are only cost-effective on the NHS if it is used in specific circumstances.

Axial spondyloarthritis affects more than 160,000 people in the UK. It most commonly affects people under the age of 45 with onset of symptoms around the age of 24.

Symptoms include back pain that wakes you up at night, morning stiffness and fatigue. Despite common symptoms, the condition can go undiagnosed for up to 8.5 years.

Ixekizumab is recommended for treating active ankylosing spondylitis that is not controlled well enough with conventional therapy, or active non-radiographic axial spondyloarthritis with objective signs of inflammation that is not controlled well enough with nonsteroidal anti-inflammatory drugs (NSAIDS).

Ixekizumab is recommended only if tumour necrosis factor (TNF)-alpha inhibitors are not suitable or do not control the condition well enough. This treatment should only be continued only if there is clear evidence of a response after 16-20 weeks.

Secukinumab is recommended for treating active non-radiographic axial spondyloarthritis with objective signs of inflammation that is not controlled well enough with NSAIDS and only if tumour necrosis factor (TNF)-alpha inhibitors are not suitable or do not control the condition well enough. This treatment should only be continued if there is evidence of a clear response after 16 weeks.

Dr Dale Webb, Chief Executive of the UK’s National Axial Spondyloarthritis Society (NASS), said: “Axial SpA is a painful and progressive long-term condition affecting approximately 1 in 200 people in the UK. It usually starts in early adulthood when people are trying to establish careers, start relationships and families.

“Axial SpA can result in long-term pain, impaired mobility and fatigue. Earlier diagnosis and treatment can have a significant impact on the progression of the condition and people’s long-term outcomes, and NASS welcomes new treatment options.”

The companies and the NHS have privately agreed on a discount for the drugs. The number of people eligible for these treatments is estimated to be around 20,000.

Lilly Subbotin