NICE has published draft guidance which recommends ocrelizumab (Ocrevus) for the treatment of relapsing–remitting multiple sclerosis (MS) in adults.
Ocrelizumab is recommended as an option only when another drug, alemtuzumab, is contraindicated or otherwise unsuitable, and the company provides ocrelizumab at the discounted price agreed in the confidential patient access scheme.
The clinical trial results show that ocrelizumab reduces relapses and slows the progression of disability compared with interferon beta-1a for people with relapsing-remitting MS.
Ocrelizumab has not been directly compared with other treatments but an indirect comparison shows that it is more effective in reducing relapses than other treatments used at this stage (interferon beta-1b, glatiramer acetate, dimethyl fumarate, fingolimod and teriflunomide), and as effective as alemtuzumab and natalizumab. However, it is uncertain whether ocrelizumab slows the rate at which the disease worsens in some people compared with these other treatments.
Ocrelizumab is given as an infusion during an outpatient appointment once every 6 months and less frequent monitoring for adverse effects is needed than with some other treatments. The committee heard that a treatment given once every 6 months, with fewer adverse effects and monitoring needs than other treatments, would be less disruptive and so be valued by patients.
The committee concluded that the most plausible cost-effectiveness estimates for ocrelizumab, taking into account the discounted price of the drug, was within the range for it to be considered a cost effective use of NHS resources. However, it is more costly and no more effective than alemtuzumab.
Affecting around 90,000 people in England, MS is a chronic, lifelong and disabling condition affecting the brain and spinal cord. The relapsing form of MS affects approximately 85-90% of people at the time of diagnosis. It is characterised by periods of remission, when symptoms are mild or disappear altogether, followed by relapses.
Stakeholders now have the opportunity to appeal against the draft recommendations.
Should there be no appeals, final guidance is expected to be published in July.