NICE ASSESSMENT OUTCOMES

Updated: 5 days ago

August 10, 2022

Opdivo was recommended for invasive urothelial cancer at high risk of recurrence.

NICE recommended the use of Bristol Myers Squibb's Opdivo (nivolumab) for treating adult patients with muscle-invasive urothelial carcinoma (MIUC) and with PD-L1 expression ≥ 1%. It was restricted to patients in which platinum‑based chemotherapy is unsuitable. BMS agreed with the commercial agreement for the recommendation.

Also read: HAS assessment outcomes


Surgery was the aim of removing cancer. The standard of care to avoid recurrence was using platinum-based chemotherapy or best supportive care.

The recommendation was based on the Checkmate 274 study, an ongoing Phase 3 clinical trial. NICE agreed that there was an increase in disease-free survival versus placebo in patients with PD-L1≥ 1%. However, overall survival gains were not established.

NICE commented that the company had not compared the cost-effectiveness of Opdivo versus platinum-based chemotherapy; CE estimates were considered appropriate only if chemotherapy is unsuitable. It was recommended under routine commissioning.

 

August 10, 2022

NICE approved Janssen's Tremfya for psoriatic arthritis

NICE recommended Janssen's Tremfya (guselkumab) for treating adult patients with psoriatic arthritis who had an inadequate response or who are intolerant to a prior disease-modifying anti-rheumatic drug (DMARD) therapy. NICE recommended Tremfya for patients who have had at least one biologic DMARD or who are contraindicated to TNF inhibitors.

Also read: 2022 FDA Approvals


Janssen has submitted two trials - DISCOVER‑1 and DISCOVER‑2. In both studies, NICE agreed that the efficacy of guselkumab is higher than placebo. Further, it agreed that the population is in accordance with NHS clinical practice.

NICE broadly agreed that the model submitted by Janssen was according to the other technology appraisals.


 

August 10, 2022

Piqray was recommended for HER2-negative PIK3CA mutated breast cancer.

NICE has recommended the use of Novartis' Piqray (alpelisib) for hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer. The product was positioned after a CDK4/6 inhibitor plus an aromatase inhibitor. Further, Novartis agreed to a commercial agreement with NICE.

The current standard of care for HR+, HER2-negative, PIK3CA mutated, locally advanced, or metastatic breast cancer after CDK4/6 inhibitor was everolimus plus exemestane. With the indirect comparison, NICE agreed that Piqray plus exemestane had shown superior efficacy.


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The recommendation was based on the BYLieve study, a single-arm study. However, NICE has not agreed to the SOLAR-1 study, as it included only 20 relevant patients.

NICE agreed that Piqray met the NICE's criteria of being a life-extending drug at the end of life. NICE agreed that the cost-effectiveness estimates are within the acceptable limits, though they are uncertain.


 

May 17, 2022

NICE recommended Verzenios for HR+, HER2-negative, node-positive early breast cancer

NICE recommended Verzenios (abemaciclib) for treating patients with hormone-positive, HER2-negative, and node-positive breast cancer. Verzenios was indicated for patients with high-risk recurrence following surgery.

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Further, NICE agreed that the treatment with Verzenios resulted in 30% better chances of cancer not returning compared to patients who were on hormone therapy alone.

NICE highlighted that nearly 50,000 have breast cancer in England, out of which 70% of patients have HER2-negative breast cancer. Cancer in almost 30% of patients will return after the initial treatment.


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May 25, 2022

Keytruda was recommended for a rare form of TNBC

NICE has published the final draft recommendation, in which Keytruda (pembrolizumab) in combination with chemotherapy (paclitaxel or nab-paclitaxel) was recommended for treating patients with triple-negative breast cancer, which has spread to other parts of the body. Merck has agreed to provide Keytruda to the NHS with a discount.

Keytruda is recommended in patients whose tumors express PD-L1 with a combined positive score (CPS) of 10 or more and immune cell staining (IC) of less than 1%.

Merck submitted KEYNOTE-355, a double-blind placebo-controlled active-comparator trial that evaluated the efficacy of Keytruda in combination with chemotherapy versus chemotherapy alone. The study showed improvement in the progression-free survival in the Keytruda arm compared to the placebo arm. Median progression-free survival was 7.6 months and 5.6 months in the Keytruda arm and chemotherapy arm, respectively. At six months, 56.4% and 47.8% of patients on Keytruda and chemotherapy alone had no disease progression or death.

Previously, Tecentriq (atezolizumab) was recommended for treating patients with untreated PD-L1 positive, advanced or metastatic, triple-negative breast cancer.

 

May 24, 2022

NICE recommended Vabysmo for two forms of sight loss

NICE has recommended Roche's Vabysmo (faricimab) for treating wet age-related macular degeneration or diabetic macular edema. NICE published the final recommendation for treating two forms of sight loss.

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It is administered as an eye injection in adult patients with wet age-related macular degeneration or diabetic macular edema. Vabysmo is administered with an interval of up to 16 weeks between two doses and is as effective as aflibercept which was administered every eight weeks.

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Up to 300,000 patients with wet age-related macular degeneration and 28,000 people with diabetic macular edema are eligible for treatment in England.

 

May 13, 2022

NICE recommended Ryeqo for women with uterine fibroids

In its final draft guidance, NICE has recommended Ryeqo (relugolix / estradiol/norethisterone acetate) for treating women with moderate to severe fibroids.

The usual treatment for uterine fibroids includes hormonal contraception and non-steroidal anti-inflammatory drugs. For treating moderate to severe patients, injectable gonadotropin-releasing hormone (GnRH) agonists are used. NICE, in its statement, mentioned that nearly 4,500 women would be eligible for the new oral treatment option.


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Uterine fibroids usually impact 1 in 3 16-50 years old and are a non-cancerous growth around the uterus. The symptoms include menstrual bleeding, pelvic pain, and fertility problems.

 

14 April 2022

NICE recommended Tepmetko for NSCLC with METex14 skipping gene alterations

NICE recommended Merck Serono's Tepmetko (tepotinib) for treating adult patients suffering from NSCLC with METex14 skipping gene alterations.

Patients with METex14 skipping gene alterations account for 1-2% of lung cancer patients in England.

Tepmetko is recommended under Project Orbis, which aims to provide access to cancer therapies faster to patients. From trial data and analyzing real-world data, it is expected that the project might increase its survival. It is expected to be recommended as first-line therapy after genomic testing.


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12 April 2022

Cefiderocol and ceftazidime-avibactam will be available in the UK under an innovative subscription-style payment model

NICE evaluated cefiderocol and ceftazidime-avibactam under the project in collaboration with NHS England and NHS Improvement, and the Department of Health and Social Care (DHSC) to develop therapies for antimicrobial resistance. It is indicated for patients who develop severe infections and are not having therapeutic alternatives.

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The main goal of the subscription-style payment model is to encourage innovation to address antimicrobial resistance. NICE highlighted that only 41 new antimicrobials are in clinical trials in 2020, compared to 1800 immuno-oncology drugs.

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In 2019, the UK government published its five-year plan to address antimicrobial resistance. The main goal is to invest in innovation and access to antimicrobial resistance. NICE agreed developing therapies for antimicrobials is not commercially attractive.

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NICE highlighted that antimicrobials are essential to ensure chemotherapy, surgery, and medical procedures go ahead, prevent the risk of infecting others, and provide multiple antimicrobials for treating antimicrobial resistance.




07 April 2022

NICE recommended Merck Serono's Bavencio for routine use in patients with urothelial cancer

NICE recommended using Bavencio (avelumab) for routine use for patients with adults with locally advanced or metastatic urothelial cancer. It is indicated in patients who were previously not treated with platinum-based chemotherapy.


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The recommendation was based on new evidence submitted by the company and the additional discount provided by Merck Serono. NICE estimated that nearly 800 patients would benefit from this new treatment option.

The recommendation was based on the JAVELIN Bladder 100 trial, in which Bavencio showed improvement in the overall survival compared to the standard of care. The risk of death was reduced by 31% in the Bavencio arm compared to SoC. There is more improvement in PD-L1 positive tumors - the risk of death was reduced by 44% in the Bavencio arm compared to SoC.

Urothelial cancer is more common in men than women; the primary risk factors include age, smoke, and industrial chemicals.




07 April 2022

NICE says Trodelvy is effective but not cost-effective

In its graft guidance, NICE has not recommended the use of Gilead's Trodelvy (sacituzumab govitecan) in patients with triple-negative breast cancer.

Trodelvy is indicated for triple-negative breast cancer that cannot be removed by surgery and the breast cancer is in the advanced or metastatic stage. It is indicated in patients who were previously treated with two other systemic therapies.

Triple-negative breast cancer accounts for 15% of breast cancer in the United Kingdom, and the annual incidence is 4,500-6,750.

The list price of Trodelvy is £ 793 per 180mg vial. The draft guidance is under public consultation until 29 April 2022.





03 March 2022

NICE recommended Amgen's Lumykras for KRAS positive NSCLC

NICE has recommended using Amgen's Lumykras (sotorasib) for KRAS 12C gene mutation of non-small-cell lung cancer. It is indicated for patients who have progressed on, or are intolerant to, platinum-based chemotherapy and/or immunotherapy.

Nearly 500 patients in England will benefit from the new recommendation. KRAS mutation is the most common mutation in the NSCLC.

Platinum-based chemotherapy and/or immunotherapy is the standard of care for NSCLC patients and is indicated after chemotherapy.






08 February 2022

Wegovy recommended for people living with obesity.

Wegovy (semaglutide) is recommended for patients living with obesity by NICE. It is recommended in patients with a BMI of 35 kg/m2, and exceptionally, to people with a body-mass index (BMI) of 30.0 kg/m2 to 34.9 kg/m2.

Wegovy is recommended for a maximum duration of two years.

Wegovy acts like a glucagon-like peptide-1 hormone, a hormone released after eating. In STEP 1 clinical trial, patients on Wegovy lost 12% more weight than those on placebo.

The 2019 Health Survey of England estimated that 28% of people in England are obese and 36% are overweight. The current cost because of obesity is £6.1 billion.



04 February 2022

NICE recommended £2.8 million drug for metachromatic leukodystrophy

NICE has recommended using Libmeldy (atidarsagene autotemcel), a gene therapy from Orchard Therapeutics for metachromatic leukodystrophy (MLD). NICE also recommended Libmeldy for patients who have symptoms yet can walk.

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The one-time gene therapy costs around £2.8 million. Previously, the drug was not recommended in the draft guidance; however, the drug is recommended after giving confidential discounts.

NICE agreed that Libmeldy helps improve motor and cognitive function in the short term, and there is a probability of correcting the enzyme deficiency.


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08 February 2022

GSK's Jemparli recommended by NICE for endometrial cancer

NICE recommended using GSK's Jemparli (dostarlimab) for treating adult patients with endometrial cancer within the Cancer Drugs Fund.

Also read: 2022 FDA Approvals


Jemparli is recommended as second-line therapy in patients with endometrial cancer with high microsatellite instability or mismatch repair deficiency.


NICE agreed that there are no standard second-line treatments; there is a high unmet need in these patients.

GSK submitted the GARNET trial, phase 1 single-arm trial. The primary endpoint are objective response rate and duration of response. NICE commented that the data is immature. However, it agreed that Jemperli improves survival, but outcomes are uncertain. GSK submitted partitioned-survival model. NICE has not recommended for routine commission, but is recommended under Cancer Drugs Fund.

Endometrial cancer originates in the womb lining, and the incidence is 2,162 in the UK. NICE commented that chemotherapy administration takes a day; however, dostarlimab administration can be done within 30 minutes.




16 December 2021

NICE guidance recommended Roche's Evrysdi for SMA

NICE has published its draft guidance on Roche's Evrysdi, and it has recommended it for patients with 5q spinal muscular atrophy (SMA). It has recommended Evrysdi in 2 months of age and older patients diagnosed with either Type 1, Type 2, or Type 3 SMA or with one to four SMN2 copies.

Roche has submitted the results from the SUNFISH and FIREFISH, which NICE considered appropriate for decision-making. SUNFISH included patients with type 2 or type 3; FIREFISH included patients with type 1 SMA. NICE agreed that the evidence was sufficient to make the decision.

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Based on the JEWELFISH study, NICE agreed that Evrysdi could be recommended in patients who previously had nusinersen.

NICE agreed that there was an improvement in the motor function, but there was no evidence on overall survival data for type 1 SMA.

NICE believed that the ICER value of Evrysdi was £50,000 per QALY gained. The company has agreed to provide the managed access agreement (MAA), and NICE has recommended Evrysdi with MAA.





05 November 2021

NICE draft guidance recommended AstraZeneca's Forxiga for CKD


In the draft guidance, NICE recommended AstraZeneca's Forxiga (dapagliflozin) for treating chronic kidney disease in adults. The drug is recommended as an add-on to the standard of care (ACE inhibitors or ARBs unless they are contraindicated). Further, patients whose eGFR is in the range of 25 ml/min/1.73 m2 to 75 ml/min/1.73 m2 and uACR of 22.6 mg/mmol or more are eligible for receiving the treatment.




NICE estimated that nearly 91,000 patients in England would benefit from the treatment.

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Forxiga is a sodium-glucose co-transporter-2 (SGLT2) inhibitor and is the first SGLT2 inhibitor recommended by NICE. The drug acts by inhibiting SGLT2 protein in the kidney, thereby reducing the inflammation and pressure on the kidney.

The addition of the drug to the therapeutic strategy is expected to reduce the risk of end-stage renal disease and death.

AstraZeneca has submitted the DAPA-CKD trial in which dapagliflozin plus standard of care was compared with placebo plus standard of care. Further, the company submitted a de novo health economic model, which included a cohort-level state transition approach with six health states. NICE considered the drug cost-effective in patients included in the DAPA-CKD trial and patients with a uACR of 3 mg/mmol or more and with type 2 diabetes.






October 28 2021


NICE recommended Janssen's Erleada for prostate cancer

NICE recommended the use of Erleada for treating high-risk hormone relapsed non-metastatic prostate cancer and hormone-sensitive metastatic prostate cancer.

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In order to support the recommendation for patients with high-risk hormone-relapsed non-metastatic prostate cancer, the company has submitted SPARTAN trial. SPARTAN trial was a Phase-3, placebo-controlled study, in which apalutamide plus ADT was compared with placebo plus ADT. NICE agreed that the patients included in the study reflected people in NHS clinical practice. The median overall survival was 73.9 months in apalutamide plus ADT group versus 59.9 months in placebo arm. Metastasis-free survival in apalutamide plus ADT was 40.5 months versus 15.7 months in placebo arm. NICE agreed with the model submitted and considered that the drug to be cost effective.

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To support the recommendation for patients with hormone-sensitive metastatic prostate cancer, the company submitted TITAN Phase 3 results. In the trial, apalutamide plus ADT was compared with placebo plus ADT. Median radiographic progression-free survival was not reached in apalutamide plus ADT, it was 22.1 months in placebo arm. The company submitted a partition survival model, and NICE has considered it to be cost-effective.




October 5 2021


NICE says yes to Novartis' Adakveo for sickle cell disease

NICE accepted Adakveo for recurrent sickle cell crises (vaso-occlusive crises) in patients with sickle cell disease. The drug is indicated for patients of age 16 years and above.

Hydroxycarbamide is the standard of care for patients with SCD. Blood transfusions are recommended for patients for whom hydroxycarbamide cannot be administered.

The recommendation was based on the SUSTAIN trial, a double-blind, placebo-controlled study. The primary endpoint is the annual rate of sickle cell-related

pain crises; the median sickle cell-related pain crises reduced significantly in the Adakveo arm versus placebo arm. However, there was uncertainty over the long-term clinical effectiveness.

NICE has initially not recommended Adakveo considering it not to be cost-effective, however, the company has provided managed access agreement. Considering the access agreement, NICE recommended the use of Adakveo. Novartis proposed considering the data under managed access agreement, to address uncertainties of long-term clinical effectiveness.

The STAND trial and National Haemoglobinopathy Registry will be considered for collecting the additional data.

 

May 16 2021

NICE recommended the use of Opdivo in advanced, recurrent, or metastatic esophageal squamous cell carcinoma patients


NICE recommended using Opdivo in patients with advanced, recurrent, or metastatic esophageal squamous cell carcinoma. The drug is recommended after fluoropyrimidine and platinum-based therapy.


Also read: Denmark Healthcare System


The company submitted ATTRACTION‑3 trial in its dossier; people were administered with either nivolumab or taxane chemotherapy. Opdivo showed an improvement in the median overall survival of 2.4 months versus chemotherapy. But NICE observed that the progression-free survival and overall response rate were lower in the Opdivo arm.


NICE commented that there is uncertainty over the method used for extrapolating overall survival. Considering the commercial access agreement, NICE agreed that Opdivo is cost-effective.


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NICE said OK to Kesimpta to treat RRMS as first-line therapy

NICE recommended the use of Kesimpta (ofatumumab) for relapsing-remitting multiple sclerosis. The HTA body recommended using the drug as first-line therapy.


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NICE agreed that Kesimpta has the advantage of administrating at home, which increases the patient’s comfort compared to other intravenous dosage forms.

The recommendation was based on Phase III ASCLEPIOS I (n=927) and ASCLEPIOS II (n=955); Kesimpta was compared versus teriflunomide. Kesimpta demonstrated better efficacy than teriflunomide. Further, the committee mentioned that Kesimpta reduces annualized relapse rates and slow disability progression than most comparators except monoclonal antibodies.

The list price of Kesimpta is £1,492.50 per unit.