The Department of Health and Social Care asked the National Institute for Health and Care Excellence (NICE) to produce guidance on using ocrelizumab, also known as Ocrevus, in the NHS in England.
After considering the evidence submitted by drug makers Roche the decision was taken to not recommend the drug for the treatment of relapsing forms of multiple sclerosis (MS), adults with active disease defined by clinical or imaging features.
NICE made it clear in its consultation that it has already approved a number of highly effective drugs for relapsing forms of MS and because Ocrevus didn’t provide evidence directly comparing itself to those drugs currently available, it wasn’t sure the costly drug currently has a place with the others.
Current NHS treatments for relapsing forms of MS include alemtuzumab, beta interferons, cladribine, dimethyl fumarate, fingolimod, glatiramer acetate, natalizumab and teriflunomide.
The appraisal consultation document explained why NICE took this stance on the decision. It said: ‘Clinical trial results show that ocrelizumab reduces the number of relapses and slows disability progression compared with interferon beta-1a for people with relapsing remitting multiple sclerosis. There is no evidence directly comparing ocrelizumab with other treatments. Indirect analyses suggest that ocrelizumab reduces the number of relapses compared with interferon beta-1b, glatiramer acetate, dimethyl fumarate, fingolimod and teriflunomide, and is as effective as alemtuzumab and natalizumab. However, from these analyses, it is uncertain whether ocrelizumab slows disease progression compared with other treatments, particularly in the subgroups of highly active disease and rapidly evolving severe disease.’
It continued to state that ‘the most plausible cost-effectiveness estimates for ocrelizumab compared with all relevant comparators are higher than those NICE normally considers an acceptable use of NHS resources’, suggesting that cost is also a factor in its decision.
However, NICE did stress that this recommendation is not intended to affect treatment with ocrelizumab that was started in the NHS before this guidance was published. People having treatment outside this recommendation 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.
Source: MS-UK 12/04/18