Ublituximab is recommended as an option for treating relapsing forms of multiple sclerosis, defined as active by clinical or imaging features in adults, only if:
the multiple sclerosis is relapsing–remitting, and
the company provides it according to the commercial arrangement.
Use the least expensive option of the available treatments (including ublituximab, ocrelizumab and ofatumumab). Take account of administration costs, dosages, price per dose and commercial arrangements. If the least expensive option is unsuitable, people with the condition and their healthcare professional should discuss the advantages and disadvantages of other treatments.
This recommendation is not intended to affect treatment with ublituximab 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 healthcare professional consider it appropriate to stop.
Why these recommendations were made
Treatment options for active relapsing–remitting multiple sclerosis include immunomodulatory treatments such as teriflunomide and anti‑CD20 monoclonal antibodies such as ocrelizumab and ofatumumab. Ublituximab is another treatment option that works in a similar way to ocrelizumab and ofatumumab and would be offered to the same population.
Clinical trial evidence shows that ublituximab is more effective at reducing the number of relapses than teriflunomide. Ublituximab has not been directly compared in a clinical trial with ocrelizumab and ofatumumab. But the results of an indirect comparison suggest that it is likely to work as well as these.
A comparison of ublituximab with ocrelizumab and ofatumumab using NICE's cost comparison methods suggests ublituximab has similar benefits to and lower costs than ocrelizumab and ofatumumab. So, ublituximab is recommended.
For all evidence see the committee papers. For more information of NICE's evaluation of ocrelizumab and ofatumumab, see the committee discussion sections in NICE's technology appraisal guidance on ocrelizumab for treating relapsing–remitting multiple sclerosis and ofatumumab for treating relapsing multiple sclerosis.