Myeloma drugs Darzalex and Kyprolis rejected in Scotland

Scotland’s cost-effectiveness body has blocked funding for two multiple myeloma medicines, saying evidence presented by manufacturers Janssen and Amgen did not justify their cost.

The decisions to reject Darzalex and Kyprolis were among a batch of decisions announced by the Scottish Medicines Consortium (SMC) for January.

The SMC said that it had considered Janssen’s Darzalex (daratumumab) for advanced multiple myeloma using its Patient and Clinician Engagement (PACE) process, allowing a cost-effectiveness committee more flexibility in its decision making for end of life and very rare conditions.

But the SMC said the committee was concerned over uncertainties in Janssen’s evidence, and ruled Darzalex would not be a good use of NHS resources.

For Amgen’s Kyprolis (carfilzomib), an assessment committee also used the PACE process, but was not satisfied the company’s evidence about the drug’s overall benefits was strong enough to justify its cost to the NHS.

In England, NICE is still assessing Darzalex and an assessment of Kyprolis has been put on hold, as Amgen wants two combination therapies involving the drug to be considered in a single assessment.

The news was better for Merck & Co and its Keytruda (pembrolizumab) cancer immunotherapy, which the SMC accepted for late-stage non-small cell lung cancer, also considered through PACE.

Patient groups and clinicians highlighted the extra two months or so additional survival time compared with standard of care, and the need for treatments that are better tolerated than those currently available.

The SMC also accepted Merck & Co’s Zepatier (elbasvir+grazoprevir) hepatitis C combination therapy.

Three further approvals were made: Novartis’ Exjade (deferasirox) for excess iron from frequent blood transfusions due to myelodysplastic syndrome; Qden’s Butec (buprenorphine) skin patch for cancer pain; and Correvio’s Xydalba (dalbavancin), an antibiotic for acute bacterial skin and skin structure infections in adults.


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