NICE is to due to publish guidance this month setting out what medicines adults, young people and children with asthma should take to control symptoms and reduce asthma attacks. This article reviews some of the likely recommendations and impact on clinical practice.
NICE is due to publish new guidance this month on the chronic management of asthma alongside further guidance on asthma diagnosis and management.
The draft guidance called for a change in how medicines were offered, a move NICE said could save the NHS millions of pounds.
According to Asthma UK, the NHS spends around £1 billion a year treating and caring for people with asthma and about 4.5 million people in England are receiving treatment for the condition.
Expected to be included in the recommendations, is that people should get a 7p a day tablet earlier than current practice. It estimates that every 10,000 people who take up the new recommendation could save £3 million a year.
Professor Mark Baker, director of the NICE centre for guidelines, said: “With this new guideline we want to give clear guidance on how health professionals can help people take control of their symptoms so they can live life to the fullest. We also need to make the best use of NHS resources and our guidance is the first to set out what the most clinical and cost-effective options for treating asthma are.”
Asthma UK welcomed the development of the NICE guidelines. Kay Boycott, Chief Executive at Asthma UK, said: “Anything which helps a doctor build a more complete picture of a person with suspected asthma is welcome, though tests for a definitive diagnosis of asthma are still a long way off.
“Asthma has many complex causes which is why it is very difficult to get a definitive diagnosis. It is also a highly variable condition that can change throughout someone’s life or even week by week, meaning treatment also needs to change over time. For example, people whose asthma is triggered by pollen may have no symptoms during an annual asthma review in winter and diagnostic tests might show completely different readings than if they had the same tests in summer. It’s important people with asthma work in partnership with their GP or nurse to build a complete picture of their asthma to tailor their treatment. The annual asthma review meeting is the bedrock of asthma care to ensure people with asthma get the right medication and know when to use it, and yet last year over 1 million people skipped this vital appointment.”
When the draft guidance was announced last year, Asthma UK said that the decision stakes were high surrounding two new drugs that had the potential to transform the lives of people with some of the most debilitating forms of asthma.
In an editorial2 in October, Joseph Clift, Senior Policy Officer at Asthma UK, said: “Approval for the drugs—mepolizumab and reslizumab—could offer hope to thousands of people with a form of severe asthma that doesn’t respond to current treatments. However, rejection would come as a huge blow to those that will not have seen any new targeted treatments in their lifetime.”
Mepolizumab and reslizumab have been developed to treat severe eosinophilic asthma. This is a distinct type that involves an inflammation of the airways linked to a particular type of white blood cell (eosinophils).
A similar drug, omalizumab (Xolair), became available in 2007. But while it has been transformational for some, it targets a different type of severe asthma. This is why the new drugs being considered by NICE are so important as they offer hope of new treatments to patients that have no targeted therapies available.
He added: “At a time when Asthma UK is calling for much-needed investment in asthma research from government and industry, rejection of these innovative treatments could serve as a disincentive to future asthma research.
|ASTHMA: KEY FACTS3|
“This is a crucial time for NICE, the drug developers and for people with severe asthma. We need to ensure that clinically-effective treatments are made available for people with severe asthma at a price that the NHS can afford as quickly as possible across the UK. With a further treatment, benralizumab, recently reporting encouraging clinical trial results, we could very quickly go from no targeted therapies for these patients to three— providing hope to thousands of people, stopping asthma attacks, and saving lives.”“There is no denying these are high cost treatments, but the benefits far outweigh the cost by transforming the lives of people who find themselves fighting to breathe on a daily basis. The experience of Xolair has shown that these asthma treatments can be carefully provided through specialist centres—making use of multidisciplinary teams and diagnostic tests to ensure the drugs are provided to those that will benefit most.
NICE has since recommended both these drugs and Asthma UK said that targeting the right population for these drugs is now essential.
Mepolizumab (Nucala) was recommended in December and NICE said that adults with severe symptoms should have access to the drug, including adults who suffer many asthma attacks or those taking regular oral steroids.
Mepolizumab is the first biologic treatment to target immune cells called eosinophils. These cells are responsible for symptoms in thousands of asthma patients. It stops the activity of a molecule called IL-5, which attracts asthma-causing eosinophils to airways and helps them survive.
Professor Carole Longson, director of the NICE centre for health technology evaluation, said: “Around 100,000 adults in England and Wales have severe asthma that cannot be controlled with their regular medicines. Symptoms such as constant breathlessness can make it hard to carry out simple day-to-day activities.
“Asthma attacks can come without any warning so people often live in fear, afraid to go out. If they do suffer from an attack, it may lead to hospitalisation and in the worst cases death.
“Adults with severe asthma have had limited treatment options. Many end up taking oral corticosteroids for prolonged periods which can cause further complications such as diabetes, high blood pressure and mood swings.”
GSK provided more information and reduced the price of the drug, meaning it could be recommended as cost effective for the NHS.
NICE also recently recommended reslizumab (Cinqaero) for this type of severe asthma. Reslizumab works in a similar way to mepolizumab. The recommendation came after Teva UK, which markets reslizumab, offered the NHS a confidential discounted price.
Alison Bloomer, Managing editor, GM
Conflict of interest: None declared.
2. https://www.asthma.org.uk/about/media/news/in-thebalance/#. Accessed 10/10/17
3. https://www.asthma.org.uk/about/media/news/asthma-ukscomment---nice-report/# Accessed 10/10/17