NICE Update: Tocilizumab for treating giant cell arteritis

Tocilizumab, used with a tapering course of glucocorticoids (and when used alone after glucocorticoids), is recommended for treating giant cell arteritis in adults, only if:

They have relapsing or refractory disease They have not already had tocilizumab It is stopped after one year of uninterrupted treatment at most The company provides it with the discount agreed in the patient access scheme.

Giant cell arteritis (sometimes called temporal arteritis) is a condition causing inflammation in the walls of medium and large arteries, usually in the head and neck. This causes the arteries to narrow, which restricts blood flow.

The standard treatment is a high dose of glucocorticoids, gradually reduced over time. High doses of glucocorticoids may cause a number of problems, including skin problems, weight gain, diabetes and osteoporosis.

The annual incidence of adults with giant cell arteritis is around 9,600 in England. Some 4,100 adults (43%) are estimated to have relapsing or refractory disease and will be eligible for treatment with tocilizumab. From 2019/20 once peak uptake of 10% is reached (in line with an NHS England clinical commissioning policy), 410 adults are expected to be treated with tocilizumab.

A resource impact template has been produced to support implementation of the guideline – allowing organisations to estimate the local cost. Tocilizumab has a patient access scheme, agreed between the Department of Health and Social Care and Roche, which makes it available with a commercial-in-confidence discount to the list price. Tocilizumab will be delivered at home, with the cost of training for administering subcutaneous injections being covered under the homecare programme. It is therefore assumed that VAT is not applicable to the costs of tocilizumab.

Benefits include more people being expected to stay in remission and receive lower cumulative doses of glucocorticoids compared with people having glucocorticoids alone. There may be a reduction in adverse events, the number of appointments required, and the use of concomitant medications.