NICE recommends 3 treatments for COVID-19 (Paxlovid, Tocilizumab, Baricitinib) in its draft guidance released for consultation

Three treatments for COVID have been recommended in the draft NICE guidance released for public consultation on November 16, 2022:

• Nirmatrelvir plus ritonavir (also called Paxlovid and made by Pfizer)
• Tocilizumab (also called RoActemra and made by Roche)
• Baricitinib (also called Olumiant and made by Eli Lilly and company, subject to it receiving a marketing authorisation in Great Britain for treating COVID-19)

Several other medicines are not recommended at this stage. However NICE stands ready to work with companies and NHS England to look for solutions during the public consultation.

Helen Knight, interim director of medicines evaluation at NICE, said:“Our task has been to evaluate the clinical and cost-effectiveness of treatments for COVID-19, many of which are currently being made available in England under interim UK-wide pandemic-specific access arrangements. In doing so we need to strike a balance between the effectiveness of a treatment and the best use of public funding as we come out of the pandemic, to ensure the NHS can continue to deliver maximum value to the taxpayer.

“The evidence for all the treatments we’ve looked at is highly uncertain because most of the studies were carried out before the emergence of the now dominant Omicron variant of COVID-19.”

NICE has been asked to review the clinical and cost-effectiveness of medicines currently being used in the NHS to treat COVID-19. The appraisal is about routine commissioning of these medicines and does not address their use in exceptional (i.e. pandemic) circumstances.

Although much of the clinical evidence available to the independent committee was based on studies done before the emergence of the Omicron variant, and is therefore uncertain, nirmatrelvir plus ritonavir, tocilizumab and baricitinib are recommended because there is some evidence suggesting they are effective in treating COVID-19. These treatments were found to be cost effective.

The evaluation also looks at the following treatments in the draft guidance:

• Casirivimab plus imdevimab (also called Ronapreve and made by Roche Products) and sotrovimab (also called Xevudy and made by GlaxoSmithKline) are not recommended as the independent committee reviewing the evidence felt it was highly uncertain whether these treatments were effective against the Omicron variant. The committee also noted the WHO’s and FDA’s recommendations against using casirivimab plus imdevimab and sotrovimab for the Omicron variant.
• Tixagevimab plus cilgavimab (also called Evusheld and made by AstraZeneca) is also not recommended as the committee felt it was highly uncertain whether it was effective against the Omicron variant.
• Molnupiravir (also called Lagevrio and made by Merck Sharp & Dohme) and remdesivir (also called Veklury and made by Gilead Sciences) are not recommended. While there is some clinical evidence that they are effective at treating COVID-19 they were not found to be cost effective.

Helen Knight added:“We are ready to work with all the companies whose products have not been recommended in this draft guidance, and with NHS England, to explore whether there is scope for any commercial or other solutions that could address the issues highlighted by the independent appraisal committee.

“In addition, the hospitalisation rate was found to be a key driver of cost-effectiveness and this rate has changed over time. The committee would welcome additional evidence on the most appropriate hospitalisation rate for the high-risk group to inform its decision-making. In the meantime, we would encourage anyone with an interest in this topic to send us their comments on these draft recommendations.”

This evaluation looks at treatments for COVID-19. There is a separate evaluation for tixagevimab plus cilgavimab as a prophylaxis. This means for use as a preventative medicine to protect people from developing COVID-19. NICE currently expects to publish final guidance for the appraisal of tixagevimab plus cilgavimab for prophylaxis in spring 2023.

The recommendations relating to the use of medicines for COVID-19 in the NICE rapid guideline on managing COVID-19, developed during the pandemic will be updated when NICE’s final recommendations on therapeutics for COVID-19 are published.

The recommendations published on November 16, 2022 are draft and could change following public consultation.  Until NICE publishes its final guidance, access to COVID medicines will continue to be guided by the published UK-wide clinical access policies agreed by the UK Chief Medical Officers. Once published, the final guidance will inform routine commissioning decisions for these treatments.

Recommendations and settings in the draft guidance: