Rituximab for RA patients, NICE specialist around?

[Rafael]

Just read the news about the use of Rituximab in RA patients. looks like encouraging trial for the early use of rituximab.



Hope for millions as drug stops arthritis in its tracks | Mail Online


I am very concerned about the safety/effectivity of this drug as mom has been diagonised with RA (by one dr, 2 other drs rejected the diagnosis and said it is still early to conclude). she's started on methotrexate 15mg ONCE weekly, meloxicam, folic acid to prevent anemia and sulfasalazine. sadly, i believe its RA even tho RF value was not high (while ESR value was somehow high) and all the symptoms present.

My question is, does anyone has any doubt that NICE might have rejected the use of some drugs on early stages (anti-TNF alpha, rituximab) based on economical reasons (anti-TNF alpha prescribed for one patient cost the same as treating 10 patients with Methorexate/sulfasalazine).
Last month, a rheumatologist back home said metho+sulfa are enough and historically proven to be safe, so he does not think rituximab is needed for now.

Now, what happens next? more trials to support this claim, then NICE might consider changing the guidance?
at uni, was told that NICE make the decision based on effectivity of drugs, not the monetary cost, then PCT needs to find a way to secure the funding if NICE changed the guidance.

In reality, i am not sure how honest they make these decisions. would make a big difference for my mom as back home there is no NHS and people pay for their treatments (unless they have some kind of insurance). anyone suspecting that NICE playing this game based on financial costs (more than potency/effectivity), as obviously PCTs can't secure funding to shift 500 000 RA patient from metho to rituximab (expensive drug).

I will look into how NICE works soon, any NICE specialist around?

[Shwampa]

As you might know not all RA patients have a positive RF and some people with a positive RF have no RA. The ESR is used to monitor disease activity rather than in diagnosis. The clinical features are the main factors for diagnosis.

I have to praise the first physician who started treating your mother. An early introduction of DMARDS is very important in slowing the disease.

Rituximab (Rituxan) which was used in Non-Hodgkin Lymphoma for some time got an approval in the USA for use in RA when only TNF antagonists fail to control the disease. Still, it should be given with MTX.

Like they say Health has no price but it has a cost and you'll find always health funders drag their feet before approving a costly drug if the economics don't stack up.

[Shwampa]

Now for how NICE works if you think it'll help you:

http://www.nice.org.uk/media/C18/30/...CATION2008.pdf

[lamzee]

Move to Ireland :-)

All these things are allowed on what is called the "hi-tech scheme". Consultant prescribes, pharmacy dispenses.

[Rafael]

how to deal with dizziness resulting from methotrexate (20mg), dr advised against reducing the dose to 15mg. mom says dizziness is too much to handle sometime, even considered stopping the medication.

i feel bad for not being able to answer properly! dr said do not reduce the dose as it is imp to be on a high dose initially to get a better outcome our of the treatment. i know that dizziness if a side effect of methorexate..... any advice?

[johnep]

Must say no methotrexate pt ever mentioned dizzyness as s/e. Perhaps prochloperazine may be suitable.
johnep

[Shwampa]

She can try to split the dose in 10mg am & 10mg pm or the other way around night/next morning. What's important is the whole dose need to be taken within the same 24 hrs each week. I'm sure the doctor has prescribed folic acid and her renal or liver functions are OK.

[johnep]

Major importance is that methotrexate only taken one day a week. death has followed mistaken daily dosing.
johnep

[Jeff]

how to deal with dizziness resulting from methotrexate (20mg), dr advised against reducing the dose to 15mg. mom says dizziness is too much to handle sometime, even considered stopping the medication.

i feel bad for not being able to answer properly! dr said do not reduce the dose as it is imp to be on a high dose initially to get a better outcome our of the treatment. i know that dizziness if a side effect of methorexate..... any advice?

What's wrong with the doctors advice?
Talk about living with RA - about disease progression - show her some pictures - show her the aids to living with RA. That's what the methotrexate prevents/delays. After that it is her informed decision. You might not like her decision, the doctor might not like her decision. Well tough luck - the decision is hers.

Jeff