First long-acting injectable HIV-1 treatment approved by NICE
Draft guidance, published on the 18 November, is the first time NICE has made recommendations about the use of an HIV treatment since these came under NICE's remit in 2019. It is estimated that approximately 13 000 people in England will now be eligible for treatment with cabotegravir and rilpivirine.
HIV1 is currently treated with daily antiretroviral tablets. The goal is to keep the viral load (the number of virus particles in the blood) as low as possible so that it cannot be detected or transmitted between people.
Cabotegravir (also known as Vocabria and manufactured by Viiv Healthcare) in combination with rilpivirine (also known as Rekambys and manufactured by Janssen) is recommended as an option for adults with HIV-1 infection when antiretroviral medicines have kept the virus at a low level, there is no evidence of viral resistance and there has been no previous failure of other anti-HIV-1 medicines known as non-nucleoside reverse transcriptase inhibitors (NN (INIs).
Clinical trial results show that cabotegravir in combination with rilpivirine is just as effective as oral antiretrovirals at lowering viral load. After an initial oral (tablet) lead-in period, both cabotegravir and rilpivirine are administered as two separate injections every 2 months.
Tofacitinib recommended for treating juvenile idiopathic arthritis
Tofacitinib has been recommended by the National Institute for Health and Care Excellence (NICE) as a treatment option for active polyarticular juvenile idiopathic arthritis and juvenile psoriatic arthritis in people aged 2 years and older.
This treatment option should only be considered if the following criteria are met:
- A tumour necrosis factor (TNF)-alpha inhibitor is not suitable or does not control the condition well enough
- The company provides tofacitinib according to the commercial arrangement (see NICE online for more information).
Tofacitinib can be used with methotrexate, or as a monotherapy when methotrexate is not tolerated by the patient or continued treatment with methotrexate is inappropriate.
The NICE committee has made these recommendations based on the knowledge that treatments for Juvenile idiopathic arthritis that have not responded well enough to disease-modifying antirheumatic drug include adalimumab, etanercept and tocilizumab. Evidence from clinical trials has shown that tofacitinib is effective compared with placebo. While there are no trials directly comparing tocilizumab with other treatments, an indirect comparison suggests that it has similar effects to adalimumab and tocilizumab. There is no evidence for tofacitinib compared with etanercept.
NICE highlights that this recommendation is not intended to affect tofacitinib treatment that began in the NHS before the publication of this guidance. Children and young people receiving treatment outside of these recommendations may continue to do so without affecting the funding arrangements in place prior to the publication of this guidance, until they and their NHS clinician believe it is appropriate to stop. The clinician, the child or young person and their parents or caregivers should all make this decision together.