NICE has issued a Final Appraisal Determination (rapid review of TA198) on tocilizumab for rheumatoid arthritis which states that use in combination with methotrexate is recommended as a treatment option in adults if:

• the disease has responded inadequately to DMARDs and it is used as described for TNF inhibitor treatments in NICE technology appraisal guidance 130 (Adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis), 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inhibitor and the person cannot receive rituximab because of a contraindication to rituximab, or because rituximab is withdrawn because of an adverse event, and tocilizumab is used as described for TNF inhibitor treatments in NICE technology appraisal guidance 195 (Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor), specifically therecommendations on disease activity.

or

• the disease has responded inadequately to one or more TNFinhibitor treatments and to rituximab and the manufacturer provides tocilizumab with the discountagreed as part of the patient access scheme.

The appeal period for this appraisal will close on 20 January 2012