PATIENTS with severe rheumatoid arthritis are still being denied access to drugs whose use was approved by the National Institute for Health and Clinical Excellence (NICE) three years ago.

The NICE was created to eliminate “postcode prescribing” but has no power to force the NHS to implement its recommendations. The Government has said that they are binding, but does little to enforce them.

A survey of 148 rheumatology units by the British Society for Rheumatology found that 31 per cent of doctors could not provide anti-TNF alpha drugs to all patients who qualified under Nice guidelines. The corresponding figure when the last survey was held in 2003 was 33 per cent, so improvement over the past two years has been negligible.

The NICE guidelines are strict, saying that the drugs etanercept and infliximab should be given only to patients who have tried two other treatments unsuccessfully for at least six months, and only after referral to a specialist. There are believed to be around 1,700 patients in Britain who cannot get access to the drugs. The reason given by most units is a lack of money.

The drugs are expensive, costing about £9,600 per patient per year for infliximab and £8,800 for etanercept.

David Isenberg, the president of the society, said: “It is immensely frustrating for doctors to have patients who clearly qualify for anti-TNF intervention but are unable to get it. These drugs offer hope and relief to people who have severe rheumatoid arthritis, and are likely to be affected by high levels of pain and disability, making their day-to-day living very difficult.”

Doctors also said that they were unable to help people with other arthritis-related conditions despite the clear benefits of doing so: 58 per cent were unable to prescribe the treatments for people with ankylosing spondylitis, and 53 per cent said that they were unable to prescribe the treatments for people with psoriatic arthritis. NICE is developing guidance on these treatments, but, in the meantime, the lack of approval from Nice is the main barrier to treatment.

Professor Isenberg said: “NICE guidance was developed to combat this type of inequality, but it isn’t working for all of our patients. It is wrong that some people are being left with unnecessary pain and disability. The Department of Health should remind health trusts that they need to take urgent action to ensure people get the treatment they are entitled to.”

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