Cannabis-based multiple sclerosis drug divides England and W

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Cannabis-based multiple sclerosis drug divides England and W

Postby Dave_smith » Wed Oct 08, 2014 9:02 am

Sativex, a cannabis-derived drug for treating muscle spasms in multiple sclerosis, is not recommended by Nice even though it has received green light in Wales

Drug spending authorities in England and Wales have clashed over whether a cannabis-based drug for treating pain in multiple sclerosis (MS) should be reimbursed by the NHS.
Sativex, a spray which treats painful spasms in the neurological disease, has been given the green light in Wales but not in England.
The National Institute for Health and Clinical Excellence (Nice) on Wednesday issued its final updated guidelines for MS in which it ruled that Sativex and another drug, Fampridine, should not be used as they are not cost-effective.

However an earlier assessment of Sativex by the Welsh government determined that the cannabis-based spray should be made widely available through the NHS in Wales.


This means that while the drug will be available to all MS patients in Wales, sufferers in England will only get the spray if their local commissioning group decides to ignore the Nice guidelines on Sativex.
Dr Paul Cooper, who chaired the Nice guideline group on MS, branded the Welsh decision "naive" as it accepted additional information provided by Sativex manufacturer GW Pharmaceuticals.
GW provided the Welsh medicines advisory board a study on Spanish patients that used just four sprays of Sativex a day, half that used in the studies that Nice assessed.
Nice on the other hand only considered studies conducted in UK patients that had been published in scientific journals, which assumed a dose of eight sprays a day.
"The degree of uncertainty [in the Spanish study] was so huge that even if we had received the model we would not have considered using it," said Dr Cooper, who is also a consultant neurologist at the Greater Manchester Neuroscience Centre.
"The substantial cost of Sativex and Fampridine compared to the modest benefit does not justify their use; there are better ways to improve care for people with MS," he said.
Justin Gover, chief executive of GW, called Nice's recommendation "sad and disappointing", adding that that Germany, Spain and Italy had found the drug to be cost effective.
"It's very sad that the country in which the medicine was conceived and developed is the one which is making access more difficult," he said. GW was founded in 1998 after receiving special permission from the UK Home Office to operate a cannabis farm in a secret location in the south of England, for the purposes of medical research.
He also said that Sativex is offered for free for the first month of treatment, so that that NHS will only pay for the drug in those who benefit from and continue to take it.
The MS Society said it was "concerned" by Nice's recommendation against Sativex and Fampridine since these are two of only three MS specific treatments available to patients with a progressive form of the disease.
"Surely we should be striving for the most innovative treatment and care to be made available to people with MS, not limiting options even further?" said Michelle Mitchell, chief executive of the charity.
Sativex has been licensed for use in the UK since 2010, but did not undergo a clinical assessment until this year, when Nice due updated its multiple sclerosis guidelines for the first time in a decade.
Welsh guidelines on the cost effectiveness particular drugs are normally superceded by those of Nice. But since Nice's draft recommendations resulted from a disease-wide clinical guideline and not a single drug assessment, the final outcome will not affect the Welsh advice.
About 100,000 people in the UK suffer from MS.
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