December 2015 decisions news release
The Scottish Medicines Consortium (SMC) has today published advice accepting five new medicines for routine use in NHSScotland.
Two of these medicines, lenalidomide (Revlimid) for multiple myeloma (a rare cancer of the white blood cells) and ceritinib (Zykadia) for lung cancer, were accepted after consideration under SMC’s PACE (Patient and Clinician Engagement) process, which aims to improve patient access to new medicines for the treatment of end of life and very rare conditions.
The committee was unable to accept co-careldopa (Duodopa) for advanced Parkinson’s disease, which was also considered under the PACE process.
Lenalidomide was accepted for the treatment of patients newly diagnosed with multiple myeloma who are not eligible for stem cell transplant and not suitable for treatment with a medicine in regular use, thalidomide. During the PACE meeting, patient groups and clinicians spoke about the potential for lenalidomide to improve length of life and increase patients’ ability to do normal daily activities with their families, as well as reducing the burden on carers. There are very few effective treatment options for people who are unsuitable for thalidomide.
Ceritinib is used to treat advanced non-small cell lung cancer (NSCLC) in patients who have not responded to another cancer medicine called crizotinib. It is only used if the NSCLC is ‘ALK-positive’, which means that the cancer cells have defects in the gene responsible for a protein called ALK (anaplastic lymphoma kinase). This type of cancer typically presents at a late stage when it has already spread to the brain, which can have a profound impact on quality of life and symptoms can be particularly difficult to manage. At present there are limited treatment options for this patient group, and ceritinib may help improve overall survival. Through PACE, it was highlighted that this medicine can give patients extra time that is very important in the context of limited remaining months.
The committee also accepted gefitinib (Iressa) for the treatment of advanced NSCLC in patients whose cancer cells have a gene defect that makes a protein called epidermal-growth-factor receptor (EGFR).Gefitinib offers these patients another treatment option.
Naloxegol (Moventig) was accepted for the treatment of constipation caused by analgesics (painkillers) called opioids (e.g. morphine). This is a common side effect of opioids; it can be very distressing for patients and is known to be very difficult to treat. Naloxegol offers another option for patients who have not responded to other treatments.
Also accepted was ivermectin (Soolantra), which is used to treat skin lesions (red bumps and pustules on the skin) which can occur in rosacea, a chronic inflammatory skin condition. SMC accepted ivermectin for the treatment of patients who have moderate to severe inflammatory lesions.
The committee did not accept co-careldopa intestinal gel (Duodopa) for the treatment of patients with advanced Parkinson’s disease where other medical options have been unsuccessful. Before having this medicine, patients need to have surgery as the gel is given directly into the gut (small intestine) via a pump and a tube. In the PACE meeting it was recognised that while co-careldopa can improve quality of life, it should only be used in patients who were prepared and fit enough to go through the necessary surgery. The committee was unable to accept co-careldopa intestinal gel for routine use by NHSScotland as there was too much uncertainty about the clinical benefits it would bring in relation to its cost, suggesting it may not be an effective use of NHS resources.
Dr Alan MacDonald, vice chairman of SMC, said:
“SMC is pleased to be able to accept five new medicines for routine use in NHSScotland and we hope that patients and their families will benefit from these decisions.
“The committee was unable to accept co-careldopa intestinal gel for the routine treatment of advanced Parkinson’s disease because of uncertainty about the clinical benefits the medicine would provide for this patient group in relation to its cost.”