Secukinumab is recommended by the National Institute for Health and Care Excellence (NICE) as a treatment option for treating active non-radiographic axial spondyloarthritis with objective signs of inflammation (shown by elevated C-reactive protein or MRI) that cannot be controlled sufficiently by non-steroidal anti-inflammatory drugs (NSAIDs) in adults. It is recommended only if tumour necrosis factor (TNF)-alpha inhibitors are not suitable or do not control the condition well enough.
These recommendations were made because treatment options for non-radiographic axial spondyloarthritis not controlled well enough with NSAIDs is limited to TNF-alpha inhibitors. Clinical trial evidence showed that secukinumab was effective compared with a placebo. There are no trials directly comparing secukinumab with TNF-alpha inhibitors. But an indirect comparison suggests that secukinumab may be less effective than TNF alpha inhibitors. However, this evidence is uncertain.
When treating non-radiographic axial spondyloarthritis, the results of using secukimunab should be accessed after 16 weeks. The treatment should only be continued if there is clear evidence of response, indicated by:
- A reduction in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score to 50% of the pre-treatment value or by two or more units
- A reduction in the spinal pain visual analogue scale by 2 cm or more.
Practitioners should take into account any communication difficulties, or physical, psychological, sensory or learning disabilities that could affect responses to the two questionnaires, and make any appropriate adjustments.
Secukinumab is only considered to be cost effective for people who cannot have TNF-alpha inhibitors, or when TNF-alpha inhibitors have not worked well enough. Therefore, it is recommended in these situations only.
Enzalutamide for treating hormone-sensitive metastatic prostate cancer
Enzalutamide plus androgen deprivation therapy (ADT) is recommended by NICE, within its marketing authorisation, as an option for treating hormone-sensitive metastatic prostate cancer in adults.
Current treatment for hormone-sensitive metastatic prostate cancer on the NHS is ADT alone, or docetaxel plus prednisolone or prednisone (from now, docetaxel) plus ADT. Enzalutamide plus ADT would present another option for patients with hormone-sensitive metastatic prostate cancer, especially for those who cannot have docetaxel. It is taken orally, so is more convenient than docetaxel, which is an intravenous treatment.
Trial results suggest that, compared with ADT alone, enzalutamide plus ADT increases the time until the cancer progresses and how long people live. Also, an indirect comparison suggests that, compared with docetaxel plus ADT, enzalutamide plus ADT increases the time until the cancer progresses. But, it is unclear whether there is a difference between the two treatments in the length of time people live.