January 2020 decisions news release

Medicines which can be used to treat prostate cancer, primary progressive multiple sclerosis, a rare form of lymphoma and migraine have today (Monday 13 January) been accepted by the Scottish Medicines Consortium (SMC) for use by NHSScotland.

Abiraterone acetate (Zytiga), used in combination with androgen deprivation (hormone) therapy, was accepted for the treatment of newly diagnosed metastatic prostate cancer. The medicine was considered through SMC’s Patient and Clinician Engagement (PACE) process, which is used for medicines to treat end of life and very rare conditions. Through PACE, patient groups and clinicians highlighted that metastatic prostate cancer is an incurable life limiting disease, and there is a need for more treatments, particularly for those patients who are unsuitable for chemotherapy. Abiraterone acetate, used early in the treatment pathway, can extend the amount of high quality time patients have before the cancer returns. It can also extend overall survival compared to the use of hormone therapy alone.

Also accepted through PACE was ocrelizumab (Ocrevus) for early primary progressive multiple sclerosis (PPMS). PACE participants emphasised that PPMS is a progressive, incurable and life-long disease with gradual worsening of symptoms including fatigue, weakness, walking difficulty, bladder problems, muscle spasms, visual problems and memory difficulties. As the disease progresses, patients lose their mobility and independence leading to a reliance on family members and carers. There are currently no treatment options for PPMS. Ocrelizumab can slow the worsening of disability, allowing patients to stay active, remain in work and continue with family and caring responsibilities for longer.

Brentuximab vedotin (Adcetris) was accepted for the treatment of advanced cutaneous T-cell lymphoma (CTCL), a cancer of the white blood cells that initially affects the skin. People with CTCL usually live with their condition for many years, and experience symptoms flaring up from time to time. Many people experience itching both as a symptom and as a side effect of treatment, which can impact significantly on their quality of life. Brentuximab vedotin has the potential to reduce the burden of symptoms. It represents a valuable treatment option for patients who have had a limited response to other treatments. Additionally it has the potential to act as a bridge to stem cell transplant which may provide a cure for some patients.

Fremanezumab (Ajovy) was accepted for the prevention of migraine in adults who have at least four migraine days per month where multiple preventative treatments have previously not worked. Patient groups described how the unpredictability of the condition impacts on every part of a patient’s life, and can leave them unable to hold down jobs, form relationships or look after their family. Fremanezumab may reduce the number of days patients suffer migraines and has the potential to improve quality of life.

SMC Chairman Dr Alan MacDonald said:

“I am pleased our committee members were able to accept these four new medicines for use by NHSScotland.”

“Through our PACE process, we heard how the symptoms of metastatic prostate cancer get worse as the disease progresses, placing a heavy burden on patients and carers who are already dealing with the knowledge that the condition is life limiting. Our decision on abiraterone acetate means there is now a further treatment option for patients and an alternative to early chemotherapy, which can help extend the amount of high quality time patients have.“

“Participants in our PACE meeting for ocrelizumab told us that there are currently no treatments for those with primary progressive multiple sclerosis. Our decision on this medicine provides a treatment option that can delay the progression of disability, and we know it will be welcomed.”

“Brentuximab vedotin offers a valuable treatment option for patients with cutaneous T-cell lymphoma who have had a limited response to other treatments and for some may act as a bridge to potentially curative stem cell transplant.”

“From the evidence provided to us by patient groups, we know that our decision on fremanezumab will be welcomed by those suffering from migraine who have not responded to previous treatments.”

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