NICE has issued final guidance (rapid review of TA 247) on the use of tocilizumab for rheumatoid arthritis following a new patient access scheme which the manufacturer has agreed with the Department of Health.

This guidance replaces NICE technology appraisal guidance 198 issued in August 2010 and makes the following recommendations:

1.1 Tocilizumab in combination with methotrexate is recommended as an option for the treatment of rheumatoid arthritis in adults if:

• the disease has responded inadequately to disease-modifying anti-rheumatic drugs (DMARDs) and it is used as described for tumour necrosis factor (TNF) inhibitor treatments in Adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis (NICE technology appraisal guidance 130), specifically the recommendations on disease activity and choice of treatment or

• the disease has responded inadequately to DMARDs and a TNF inhibitor and the person cannot receive rituximab because of a contraindication to rituximab, or because rituximab is withdrawn because of an adverse event, and tocilizumab is used as described for TNF inhibitor treatments in Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor (NICE technology appraisal guidance 195), specifically the recommendations on disease activity or

• the disease has responded inadequately to one or more TNF inhibitor treatments and to rituximab

• and the manufacturer provides tocilizumab with the discount agreed as part of the patient access scheme.

1.2 People currently receiving tocilizumab for the treatment of rheumatoid arthritis who do not meet the criteria in 1.1 should have the option to continue treatment until they and their clinicians consider it appropriate to stop