A systematic review of the effectiveness of adalimumab

Since the last NICE guidance the use of TNF
inhibitors to treat RA has become established
practice in rheumatology in the UK. Use of
infliximab requires day-case facilities by
rheumatology departments because it is given
intravenously. At present, there is great variation
in use of day-case facilities by rheumatologists,
determined in part by local resources of inpatient
and outpatient facilities. Widespread use of
adalimumab and etanercept places a greater
demand on outpatient facilities and requires
greater involvement of outpatient nurses in order
that patients and carers may be taught to selfadminister
injections, and to provide back-up in
case of difficulties and disease and drug
monitoring services. Again, there are great
variations in use of nurse specialists in
rheumatology and relatively few training
opportunities for nurses wishing to specialise in
Chapter 6
Factors relevant to the NHS
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Health Technology Assessment 2006; Vol. 10: No. 42
this area. However, increasing use of DMARDs has
led to an increasing requirement for specialised
nurses.
The long-term impact of TNF inhibitors on joint
failure and the likelihood of orthopaedic surgery
cannot be demonstrated directly at present
because the agents are still relatively new.
Surrogate end-points such as radiographic change
suggest potentially important benefits, and
potentially a reduced demand for surgery, but the
clinical relevance of reported radiographic
changes is debated. 45
Finally, issues of equity have been highlighted by
the wide variation in availability of TNF inhibitors
across the UK, and these have continued despite
NICE guidance.
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