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Last updated:31st May 2017

Working with NICE

NICE Spondyloarthritis Guideline

NASS has sucessfully campaigned for NICE to produce guidelines on spondyloarthritis

Debbie Cook, Chief Executive at NASS has been a member of the Guideline Development Group working with NICE for over two years, particularly giving the patients’ perspective. 

The Guideline was issued at the end of February 2017. 

NASS will be working hard to promote the guideline and to ensure the recommendations contained within them are taken on board. We welcome this guideline and we’ll keep you informed of the impact it has on diagnosis and care.

You can read the guideline on the NICE website.

NICE anti TNF guidelines for AS

NASS worked with NICE on the appraisal for the anti TNF drugs back in 2008. This gave people with AS access to adalimumab (Humira) and etanercept (Enbrel). We worked with NICE again in 2011 when another anti TNF golimumab (Simponi) was approved for AS. in 2014 The Department of Health asked the National Institute for Health and Care Excellence (NICE) to produce guidance on using anti TNF therapy for AS and non radiographic axial spondyloarthritis.

NICE have now published the new guidance we are delighted to announce that we have obtained everything that we campaigned so hard for.

All the available anti TNF therapies are recommended as options for treating AS

This means you and your rheumatologist can choose any of the anti TNF therapies on the market, including infliximab (cheapest version). Previously infliximab was not available to people with AS on the grounds of cost.

NICE recommend the choice of treatment should be made after discussion between the rheumatologist and the patient about the advantages and disadvantages of the treatments available.

Adalimumab (Humira), certolizumab pegol (Cimzia) and etanercept (Enbrel) are recommended, as options for treating severe non-radiographic axial spondyloarthritis

This means that anti TNF therapy can now be used earlier. The previous guidance specified that people needed a diagnosis of AS, where changes to the sacroilliac joints and /or the spine could be seen on x-ray. This left some people living in pain as they had all the symptoms of AS, but they did not have changes on x-ray.

Now the guidance includes people with non-radiographic axial spondyloarthritis which is where no changes are yet visible on x-ray. If you have previously been told that your x-ray or MRI results don't meet the criteria for you to go onto anti TNF therapy, it may be time to ask again.


Treatment with another anti TNF is recommended for people who cannot tolerate, or whose disease has not responded to, treatment with the first TNF-alpha inhibitor, or whose disease has stopped responding after an initial response

Until now, NICE guidance only allowed people to try one anti TNF, unless they had side effects in the first 12 weeks. If the first anti TNF didn't work or if effectiveness wore off over time, NICE did not recommend trying another anti TNF.

Now your rheumatologist can think about trying you on another anti TNF if your first anti TNF didn't work or if the effect has worn off over time.

Secukinumab (Cosentyx®) recommended by NICE for AS

NICE has published Guidance recommending secukinumab (Cosentyx®) as an option for treating active AS in adults whose disease has responded inadequately to conventional therapy (non-steroidal anti-inflammatory drugs or TNF-alpha inhibitors).

The Tachnology Appraisal Guidance was published on 28 September 2016. 

The Scottish Medicines Consortium (SMC) has also completed its assessment of secukinumab and we are also delighted to report that it has been accepted for use within NHS Scotland. It can now be used in the treatment of active ankylosing spondylitis (AS) in adults who have responded inadequately to conventional therapy.

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