NICE backs 'less-effective' Otezla to give psoriatic arthritis patients a pill option


Celgene’s Otezla is picking up steam in the U.K. Shortly after winning NICE support in severe psoriasis, the immunology med now boasts the cost watchdog’s initial backing in psoriatic arthritis.

The agency's blessing follows a previous rejection, and two things made all the difference: The fact that it's a pill among a sea of injectable treatments, and the discount Celgene offered to change NICE's mind. The latest draft is up for review at a meeting in early November.

Otezla, at a list price of £550 for a 28-day pack, is “a less effective treatment” than existing meds, NICE said in its guidance, but can provide a welcome alternative to its rival injections. The institute’s experts felt that “some patients may be willing to accept a certain level of reduced effectiveness” to be able to take an oral medication for psoriatic arthritis.

Tuesday’s recommendation marks a reversal of last year's decision, when NICE said costs for the Celgene med wouldn't justify its benefits in the indication.

In the latest guidance, NICE said its committee “agreed that apremilast could improve patient choice while also offering the opportunity of cost savings for the NHS … . It concluded that apremilast could be recommended as a cost-effective use of NHS resources.”

The recommendation comes after NICE’s August decision to recommend Celgene’s med in severe psoriasis. That was another turnabout from a ruling last year, and again a reversal contingent on a discount.

While NICE decisions directly affect patients in the U.K., other countries use the agency’s assessments to shape their own coverage, giving added gravity to judgments by the U.K. agency.

Outside of England, Otezla has run into hurdles in Germany, whose cost regulators have also cast doubts on its cost effectiveness.

But the decision will likely provide a boost for an anti-inflammatory med that competes with some of the world’s heavyweights. In a push for peak sales in the blockbuster zone, Celgene’s Otezla is going up against AbbVie’s Humira, Amgen’s Enbrel, and Merck & Co. and Johnson & Johnson’s Remicade

Next-gen entrants Cosentyx from Novartis and Taltz from Eli Lilly have also joined the fray in the last year, and biosimilar versions of the older meds are either on their way or, in the U.K., already taking a bite out of domestic brand sales. Merck's Remicade sales have suffered more than expected since a biosim hit that market.

Analysts expect Otezla to hit $1.3 billion by 2018 sales, but Celgene is shooting for $2 billion in peak sales. As part of the effort, the New Jersey-based Big Biotech has kicked off TV and print ad campaigns.

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