People with a severe back-pain condition are set to be
given a new drug that can halt the disease in its tracks and protect them from
permanent spine damage.
اضافة اعلان
Until now, the powerful treatment — a self-administered
injection — has been reserved for those with the most advanced disease. But
from this week the
NHS will get the green light to offer the DIY jabs to those
in the early stages.
The drug, secukinumab, is designed to treat
spondyloarthritis, an umbrella term for a number of conditions in which the
immune system, for unknown reasons, turns inwards and attacks healthy spinal
joints.
This leads to inflammation, stiffness and pain and, in the
long term, damage to the spine itself.
The condition has two main sub-types: non-radiographic axial
spondyloarthritis, in which there is no damage to the spine visible on
X-rays,
and ankylosing spondylitis, in which the damage can be seen.
In both types, the main symptom is back pain and stiffness
that gets worse after inactivity and eases after exercise. Patients often
suffer more at night, leading to difficulty sleeping, and stiffness in the
morning. Eye and bowel problems and fatigue are further symptoms.
More than 200,000 Britons are affected by these conditions
and most start to experience problems in their 20s.
Historically, spondyloarthritis was difficult to detect
before damage was visible on X-rays, and there is currently an average
eight-year delay in diagnosis from the first onset of symptoms.
Advances in scanning techniques and testing mean
spondyloarthritis is now possible to spot at an earlier stage. However, many
patients delay seeking help, as back pain is such a common complaint. Pain in
the buttocks area is often initially misdiagnosed as sciatica, a condition
caused by compressed nerves in the lower back. In about half of cases,
non-radiographic axial spondyloarthritis progresses to ankylosing spondylitis.
Secukinumab, also known by the brand name Cosentyx, is
already given to patients suffering from ankylosing spondylitis.
Studies showed that 45 per cent of patients on secukinumab
saw a significant improvement in symptoms, including reduced pain and
stiffness, after 16 weeks of treatment. Now, prescribing watchdog the
NationalInstitute for Health and Care Excellence (NICE) has approved secukinumab for
use in those with non-radiographic axial spondyloarthritis.
The drug, known as a biologic therapy, works by interfering
with proteins produced by the immune system that cause inflammation. This leads
to long-term relief. Consultant rheumatologist Dr Raj Sengupta, at the Royal
National Hospital for Rheumatic Diseases in Bath, said: ‘We know that the pain
and suffering experienced by patients with the earlier-stage, non-radiographic
form of the disease can be just as severe as those in the later stages.
“The hope is that if we can get the treatment to the right
patients earlier, the response rate will be better and we’ll have more chance
of slowing down irreversible spine damage.”
He added: “These are horrible, disabling conditions, and
secukinumab gives patients their quality of life back. Many of them call it a
‘miracle’
drug.”
Dr Sengupta is backing a new campaign by the National Axial
Spondyloarthritis Society aimed at reducing time to diagnosis to one year. He
says: ‘”If patients and GPs reading this recognize the characteristic symptoms
— back pain and stiffness that’s worse with rest and better after activity,
waking with pain at night, and stiffness in the morning — they should seek a
referral to a rheumatologist straight away so we can carry out tests.”
Spondyloarthritis is thought to be caused by a problem with
the immune system. Treatment involves an injection once a week for five weeks,
followed by a single jab once a month from then on.
Secukinumab comes in pre-filled, single-dose injector
‘pens’. Each pen costs about £600 privately, so if a patient were to pay for
the treatment themselves, it would cost roughly £10,000 in the first year, and
£7,200 a year subsequently.
But NICE negotiates special “bulk discount” deals, meaning
that the NHS would be expected to pay far less than this.
One patient who has already seen the benefits of the
treatment is 42-year-old businesswoman Clair McGrath. She had suffered
life-ruining back pain for 12 years before being diagnosed with
non-radiographic axial spondyloarthritis in 2016.
Clair says: “I started getting pains in my lower back when I
was about 25, after the birth of my daughter. Initially, the doctor thought it
was related to the pregnancy and I was told it would go away. But it didn’t.
The pain was particularly bad at night — so much so that sometimes I slept on
the floor.”
Eventually, suffering extreme fatigue and a pain in her
pelvis, Clair returned to her GP and was referred to a rheumatologist, who
diagnosed her. She was put on secukinumab a year later, and the transformation
has been remarkable.
“The main change for me is that the fatigue is gone,” she
says. “I feel sharper and have more stamina. I’ve been able to take up swimming.
“When I first started to take it, I thought, ‘This must be
what being normal feels like.’ I’d forgotten, as I’d been ill for so long.”’
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