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NICE: Adalimumab and Rituximab for the treatment of arthritis

The NICE ( National Institute for Health and Clinical Excellence ) has published final guidance on the use of Rituximab ( Mabthera; US: Rituxan ) for the treatment of rheumatoid arthritis and Adalimumab ( Humira ) for the treatment of psoriatic arthritis, as part of its rapid single technology appraisal ( STA ) work programme.

NICE recommends:

• Rituximab in combination with Methotrexate is recommended as a treatment option for adults with severe active rheumatoid arthritis who have had an inadequate response to or intolerance of other disease modifying anti-rheumatic drugs ( DMARDs ). This should include treatment with at least one tumour necrosis factor ( TNF ) inhibitor therapy.

• Treatment with Rituximab plus Methotrexate should be continued only if there is an adequate response following initiation of therapy.

• Adalimumab is recommended as a treatment option for adults with active and progressive psoriatic arthritis when the person has peripheral arthritis with three or more tender joints and three or more swollen joints, and the psoriatic arthritis has not responded to adequate trials of at least two standard disease-modifying anti-rheumatic drugs.

• Adalimumab treatment should be discontinued after 12 weeks in adults whose psoriatic arthritis has not shown an adequate response.

Rituximab is a genetically engineered chimeric monoclonal antibody that depletes the B-cell population by targeting cells bearing the CD20 surface marker.

Adalimumab is a recombinant human monoclonal antibody that binds specifically to TNF-α, blocking interaction with its cell-surface receptors and thereby limiting the promotion of inflammatory pathways.

Source: NICE, 2007