In this review of tocilizumab for rheumatoid arthritis in the Drug and Therapeutics Bulletin (DTB), the authors consider whether it offers any advantages over other biological agents. They note that though in combination with methotrexate, it has been shown to be more effective than methotrexate alone in adults with moderate to severe active disease with previous inadequate response to, or intolerance to, one or more DMARDs or TNF blockers, such uses have not been shown to be cost-effective. Rituximab, on the other hand, has been shown to be cost-effective in this setting. There is also a lack of cost-effectiveness data on use of tocilizumab monotherapy. The authors note that the range of unwanted effects with tocilizumab is similar to other biological agents. They conclude that though tocilizumab has useful effects, it is unclear whether its use in the NHS can be justified.

In its second Appraisal Consultation Document (ACD) issued in December 2009, NICE did not support the use of tocilizumab and requested further information from the manufacturer in preparation for its third Appraisal Committee meeting in February 2010.