NICE recommends liraglutide & venetoclax + obinutuzumab, but not nivolumab
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NICE recommends liraglutide & venetoclax + obinutuzumab, but not nivolumab In draft guidance, the UK National Institute for Health and Care Excellence (NICE) has recommended liraglutide [Saxenda; Novo Nordisk] for the management of obesity, venetoclax + obinutuzumab for untreated chronic lymphocttic leukaemia (CLL), but has not recommended nivolumab [Opdivo; Bristol-Myers Squibb] as adjuvant treatment after melanoma surgery.1,2,3
Liraglutide NICE has recommended liraglutide for the management of obesity in adults with non-diabetic hyperglycaemia who have a body mass index of 35 kg/m or greater and are at high risk of cardiovascular disease because of hypertension or high cholesterol levels. Saxenda is recommended alongside a reduced calorie diet and increased physical activity, and will be available in pre-filled injection pens which will be prescribed in secondary care by a specialist multidisciplinary tier 3 weight management service for patients who have previously been offered weight management interventions in an intensive lifestyle change programme. Draft guidance advises that Saxenda should be discontinued if bodyweight reduction of 5% or greater has not been achieved after 12 weeks on the full dose. Treatment should be discontinued in all patients after two years. NICE was able to recommend Saxenda after Novo Nordisk agreed on a confidential discount with NHS* England and NHS Improvement (NHSE/I) which reduces uncertainty in the cost-effectiveness estimate. "Our independent committee was presented with clinical evidence which showed that people lose more weight with liraglutide plus lifestyle measures than with lifestyle measures alone. Liraglutide may also delay the development of type 2 diabetes and cardiovascular disease and this is the main benefit of treatment," said Meindert Boysen, director of the Centre for Health Technology Evaluation at NICE, "After NICE was previously unable to recommend liraglutide, we are pleased the company was able to agree a confidential discount which allowed the committee to recommend it". Consultees have 15 days to appeal against the recommendations in the final draft guidance.
Venetoclax + obinutuzumab In final drat guidance, NICE has recommended venetoclax plus obinutuzumab as first-line treatment for patients with untreated CLL. Specifically, patients with a 17p deletion or TP53 mutation, and those who have no 17p deletion or TP53 mutation but are unsuitable for treatment with fludarabine plus cyclophosphamide and rituximab (FCR), or bendamustine plus rituximab (BR) can be treated. The recommendation is dependent upon a commercial agreement with the company. Patients without a 17p deletion or TP53 mutation, and for those who are suitable FCR or BR, treatment with venetoclax plus obinutuzumab can be an option within the Cancer Drugs Fund while more data are collected in these groups.
Nivolumab For the last two years, nivolumab was recommended for use within the Cancer Drugs Fund (CDF) for the adjuvant treatment of completely resected malignant melanoma in adults w
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