Scotland first UK nation to routinely offer HIV PrEP

Scotland will become the first UK nation to routinely offer HIV pre-exposure prophylaxis to all eligible patients after the Scottish Medicines Consortium backed the use of Gilead’s Truvada alongside four other new therapies to be funded by the NHS.

In clinical trials Truvada (emtricitabine/tenofovir disoproxil) was shown to cut the relative risk of acquiring HIV infection by up to 86 percent compared with placebo or no prophylaxis.

Also, a recent evidence summary by the National Institute for Health and Care Excellence suggests that the provision of PrEP may increase access to other health services such as HIV testing, sexually transmitted infection and hepatitis B screening and support for high-risk sexual behaviour.

It is hoped that the once-daily pill - which has an NHS list price of £355 a month - could have a significant impact on disease prevalence, given that current prevention methods have not been able to cut the number of new diagnoses of HIV in Scotland in the past ten years.

Elsewhere, AbbVie/Janssen’s Imbruvica (ibrutinib) was accepted for use by the SMC to treat chronic lymphocytic leukaemia (CLL) in patients with disease that has relapsed after previous therapy.

Through its Patient and Clinician Engagement (PACE) process, patient groups and clinicians highlighted that CLL, a rare, debilitating cancer of the blood, has a significant impact on patients and their families, and that Imbruvica can delay disease progression and potentially improve quality of life.

Biogen’s Zinbryta (daclizumab) can be used to treat severe or relapsing forms of multiple sclerosis (MS).

The drug, a human monoclonal antibody that modulates interleukin-2 signalling to reduce central nervous system pathology, is a disease modifying treatment option that can reduce the frequency of relapses and the progression of disability.

Also, it can be self-administered by the patient as a monthly injection so may be more convenient than other treatment options, the SMC noted.

The cost regulator also accepted Taltz (ixekizumab) for the treatment of plaque psoriasis, extending the range of disease modifying treatment options for patients who have failed to respond to standard therapies, and Roche’s Kadcyla for breast cancer (see separate PharmaTimes article).

On the downside, the SMC said it was unable to recommend long-term (post one-year) use of Brilique (ticagrelor) to prevent problems caused by blood clots and hardening of the arteries such as heart attacks or strokes, because of uncertainties around the overall clinical benefit balanced against the potential side effects seen in clinical practice.