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Latest NICE Guidance: Asthma, dementia and more

NICE recommends wider use of abatacept for treating rheumatoid arthritis

NICE has recommended abatacept (Orencia) for rheumatoid arthritis after conventional drug treatments (disease-modifying anti-rheumatic drugs, DMARDs) have failed. This new guidance will widen the choice of treatments available at this stage of the treatment pathway. NICE has already recommended the TNF inhibitors adalimumab, etanercept, infliximab, certolizumab pegol and golimumab, and also the drug tocilizumab, for some people with rheumatoid arthritis as options for use at this stage.

The new recommendations say that abatacept in combination with methotrexate is recommended as an option for treating people with rheumatoid arthritis only if:

  • The disease has responded inadequately to two conventional non-biological DMARDs, including methotrexate, and it is used in line with the recommendations for other biological DMARDs in Adalimumab, etanercept and infliximab for the
  • treatment of rheumatoid arthritis (NICE technology appraisal guidance 130); and The manufacturer provides abatacept with the discount agreed in the patient access scheme.

NICE has previously recommended abatacept and other drugs as an option for people with rheuma- toid arthritis if there has been an inadequate response to one or more TNF inhibitors and who cannot receive rituximab because it is contraindicated or withdrawn because of an adverse event (guidance TA195, August 2010).

The guidance is available on the NICE website


NICE recommends asthma drug

In April 2013, NICE published guidance recommending omalizum- ab (Xolair, Novartis Pharmaceuticals UK) as an option for treating severe, persistent confirmed allergic immunoglobulin E (IgE)-medi- ated asthma in people aged six years and older, as an add-on to optimised standard therapy for those people who need continuous or frequent treatment with oral corticosteroids (defined as four or more courses in the previous year), only if the manufacturer makes omalizumab available with the agreed patient access scheme.

Omalizumab has a UK marketing authorisation as an add-on therapy to standard care to improve control of asthma in adults

and adolescents (12 years and over) and children aged six to 11 years old with severe persistent allergic asthma. It was previously only offered to those whose asthma remains poorly controlled despite receiving optimised standard therapy.

Omalizumab works by blocking IgE antibodies from attaching to allergens. When IgE attaches to an allergen, it sets off a process that eventually leads to an

allergic reaction. This appraisal on omalizumab for treating

severe, persistent allergic asthma is a review of NICE technology appraisal guidance 133 (omalizumab for severe persistent allergic asthma in adults, 2007) and NICE technology appraisal guidance 201 (omalizumab for the treatment of severe persistent allergic asthma in children aged six to 11 years, 2011). TA133 recommend- ed omalizumab for adults, and TA201 did not recommend it for use in children.

The full guidance can be found at:


NICE outlines high-priority areas to help people with dementia live well

In its first quality standard for social care, NICE states people with dementia should be given the same opportunities to maintain their mental and physical health and wellbeing as those who do not have the condition.

Around 670,000 people in England are living with dementia and one in three people over the age of 65 will develop the condition. Symptoms mean that people with dementia are not always in a position to seek help or advice about issues affecting their health and wellbeing.

NICE's new quality standard outlines ten statements, which are high-priority areas that will help people with dementia to live well. They draw on guidance that the Institute has published or accredited.

NICE states high-quality care providers will be those that ensure people with dementia have access to services that can help to maintain their physical and mental health and wellbeing, both routinely and when they have concerns. This could include check-ups with GPs, dentists and opticians, as well as with hearing therapists, physiotherapists and support to stop smoking.

Other statements include:

  • People who are worried about dementia, either for themselves or someone they know, can discuss their concerns, and the options of seeking a diagnosis, with someone with knowledge and expertise.
  • People with dementia, with the involvement of their carers, have choice and control in decisions affecting their care and support.
  • People with dementia participate, with the involvement of their carers, in a review of their needs and preferences when their circumstances change.
  • People with dementia are enabled, with the involvement of their carers, to take part in leisure activities during their day based on individual interest and choice.
  • People with dementia live in housing that meets their specific needs.
  • People with dementia are enabled, with the involvement of their carers, to maintain and develop their involvement in and contribution to their community.

For further information, visit:


NICE publishes high priority areas to improve the health and wellbeing of children and young people in care

As part of its extended remit, NICE has published a quality standard on the health and wellbeing of looked-after children and young people.

There are more than 67,000 children and young people in care in England, including in foster placements, children's homes, hostels and residential schools. Experiences in these settings can influence their health and social and emotional development.

NICE's new quality standard outlines eight statements, which are high-priority areas that will improve the health and social, educational and emotional wellbeing of children and young people in care. They draw on guidance that NICE has published or accredited.

NICE states that high-quali- ty care services will be those that enable on-going opportu- nities for looked-after children, young people and those leaving care to explore and make sense of their identity and relationships. For instance, this could include ensuring they have accurate and up-to-date  personal health information, that they have contact with siblings and other people they value, and that they are helped to maintain their chosen beliefs, such as their cultural values.

Other statements in the new quality standard include:

  • Looked-after children and young people experience warm, nurturing care.
  • Looked-after children and young people receive care from services and professionals who work in partnership
  • Looked-after children and young people live in stable placements that take account of their needs and preferences.
  • Looked-after children and young people who move across local authority or health boundaries continue to receive the services they need.
  • Care leavers move to independence at their own pace.

For further information, visit: