Clinicians don’t know in advance which anti-TNF any individual will respond to; and over time, any individual may stop responding to one anti-TNF but be treated successfully with another.

The fact is that 50% of RA suffers on anti-TNF treatment have had to switch their anti-TNF drug at some point.

NICE is limiting costs by relying on 1st-drug failure

You’ve argued yourself into the silly position of suggesting that if a new anti-TNF which was 100% effective came on the scene , NICE couldn’t allow it because it would cost too much money.

‘then providing the drug to all 100 is unlikely to be cost-effective’

But NICE has already agreed to supply the drug to all 100.

I have no idea whether or not this is true, but NICE appear to believe that it is, and they are better placed to judge than a) me b) you c) any of the opponents interviewed in the Telegraph piece. It would be interesting to see how much decent trial data there is comparing the efficacy of the three drugs in people who’re refractory towards the others, and if the Telegraph were a serious publication then it would have made at least some attempt at doing so…

(as to why not just ‘one person’ – if one person refractory to the original treatment would benefit, and 99 people wouldn’t, and we can’t tell who’s who in advance, then providing the drug to all 100 is unlikely to be cost-effective.)

Might as well? but if NICE has agreed that one anti-TNF is allowed, why not a second if the first fails?

‘you’d need to show data suggesting that a reasonably high proportion of patients for whom one TNF inhibitor has failed will indeed benefit from another’

Why a ‘reasonably high proportion’? Why not just ‘one person’ – after all, NICE has already agreed in principle that a TNF is suitable; sufferers who don’t respond don’t remain on the drug.

NICE reckons that if one TNF-inhibitor fails, it’s highly likely that the others will too, so you might as well move onto treatment with something else. It bases its conclusions on trial data. The decision’s opponents are relying on anecdotal evidence and don’t cite any data…

To object to the decision sensibly you’d need to show data suggesting that a reasonably high proportion of patients for whom one TNF inhibitor has failed will indeed benefit from another, rather than just stating “many people are grumpy because they think they’re losing out”.

I can’t even get on one of these drugs at the moment, unless my initial treatment seems not to work; but these new drugs are much better than the one I’ve been put on.

I’m young enough still to be looking forward to a hugely reduced quality of life for a long time unless my consultant puts me on an anti-TNF. He told me, the last time I saw him, that he can’t do that because of NICE.