Tocilizumab, when used with a tapering course of glucocorticoids (and when used alone after glucocorticoids), is recommended as an option for treating giant cell arteritis in adults, only if:
they have relapsing or refractory disease
they have not already had tocilizumab
tocilizumab is stopped after 1 year of uninterrupted treatment at most and
the companies provide tocilizumab (branded or biosimilars) according to the commercial arrangement.
This recommendation is not intended to affect treatment with tocilizumab 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.
Why the committee made these recommendations
Giant cell arteritis is usually treated with a high dose of glucocorticoids, which is gradually reduced over time. High doses of glucocorticoids may cause a number of problems, including skin problems, weight gain, diabetes and osteoporosis.
Clinical trial results show that after having tocilizumab plus a tapering course of glucocorticoids for 1 year, more people stay in remission and need lower doses of glucocorticoids compared with people having glucocorticoids alone.
In the full population, the most plausible cost-effectiveness estimates were above the range normally considered to be a cost-effective use of NHS resource, even when tocilizumab is used for only 1 year. For the subgroup of people with relapsing or refractory disease, using the committee's preferred assumptions (including that tocilizumab is given for 1 year at most), the most likely cost-effectiveness estimate compared with glucocorticoids alone is £24,977 per quality-adjusted life year gained. This is within the range normally considered to be a cost-effective use of NHS resources, so tocilizumab is recommended.