Peninusula Health Technology Commisioning Group Commissioning Decision:- Rituximab for Severe ANCA Associated Vasculitis

[John_Mills]

The Penisula Health Technology Commissioning Group (PHTCG) has come to a decision on the use of Rituximab for severe ANCA Associated Vasculitis. Rituximab may be offered to patients who have received a Cyclophosphamide-base reigmen for induction of remission and have a major relapse or persistently active disease.

Informed consent must be obtained from the patient for this unlicensed use.

John Mills was asked to be part of the consultation process.

He reported his experiences with bladder cancer and how much it must be costing the NHS, the bladder cancer was brought on as a result of the repeated use of Cylophos. The carcinoma resulted in 3 operations and 3 short stays in hospital as well as 3 monthly checks using the "willy cam". (Cystoscopy)

John likes to think his report on his experiences had some influence on their final decision.

[John_Mills Volunteer]

Plain Language Summary

Vasculitis is a condition in which there is inflammation of the blood vessels. Some forms of vasculitis are associated with the presence of anti-neutrophil cytoplasmic antibodies (ANCA) The standard treatment for achieving remission in patients with severe ANCA-Associated Vasculitis who have a major relapse is a Cyclophosphamide regimen. However ,continued use of Cyclophos is limited by the risk of bladder cancer with the risk increasing as the patient receives more courses of Cyclophos. Rituximab is a drug given by infusion which is not licensed for use in ANCA-Associated Vasculitis but has been used to treat patients with this condition.

Evidence from a clinical trial has shown that patients with relapsing disease who receive Rituximab have a better chance of achieving remission than patients receiving the standard treatment (including Cyclophos). There is no long term information comparing the side effects of Rituximab with Cyclophosphamide.

An economic analysis has shown that the use of Rituximab to achieve remission in patients who have relapsed after receiving standard treatment (including Cyclophos) would in the long term save money for the NHS compared to other treatments.