NICE recommendations
Although not NICE's final guidance on this medicine, the draft guidance outlines the committee's current recommendations.
These are:
- Efgartigimod is not recommended, within its marketing authorisation, as an add-on to standard treatment for generalised myasthenia gravis in adults who test positive for anti-acetylcholine receptor antibodies.
- This recommendation is not intended to affect treatment with efgartigimod that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.
What does this mean?
If accepted, this means people who are not currently receiving efgartigimod through the NHS in England will be unable to access it. However, people who are already being treated will be able to continue to receive it until their doctor considers it's no long necessary.
The NICE appraisal consultation document can be read in detail here and is now open for consultation.
The NICE committee recognise that clinical trial evidence suggests that efgartigimod plus standard treatment improves symptoms and ability of people to carry out their normal activities in comparison to standard treatment alone. But they felt there was some uncertainty about the extent to which this evidence would be applicable to the people who would receive efgartigimod in the NHS under the usage being appraised.
NICE says their decision is also due to uncertainties in the economic model which makes the likely cost-effectiveness estimates for efgartigimod uncertain. The committee disagreed with some of the cost effectiveness estimates put forward by the company manufacturing efgartigimod and concluded that overall the treatment would not be within what NICE consider to be acceptable cost-effectiveness estimates for use of NHS resources.
Our response and next steps
It's very common for NICE to not recommend a treatment at this stage. The decision often changes after the consultation stage and a second committee meeting has taken place – for efgartigimod, this committee meeting is scheduled for 16 November.
The draft guidance recognises there is a clinical benefit from efgartigimod. Strong evidence was presented to NICE from clinicians and patients about both the impact of generalised myasthenia gravis on people with the condition and on caregivers; and about the positive experience of people receiving the treatment.
MDUK urges all parties to work closely together between now and November to address the challenges raised in the draft guidance and to find a solution that means new patients can benefit from efgartigimod when clinically appropriate.
How you can share your views
We will continue to work with all parties involved and to present the patient voice in partnership with Myaware.
If you are currently receiving efgartigimod and are affected by this news, we are keen to hear from you so we can incorporate your views into our response.
Please do get in touch by emailing our Campaigns teams
Those affected by this announcement can get in touch by ringing 0800 652 6352 between 10am-2pm on Monday to Friday. Alternatively, you can email us on info@musculardystrophyuk.org