The National Institute for Health and Clinical Excellence, an organization that decides which treatments will be made available under the state-funded National Health Service in the United Kingdom, recommended thalidomide as a first line of treatment for multiple myeloma patients in a draft guidance published August 26. Velcade was also recommended as a first line of treatment, but only for patients unable to tolerate thalidomide.

This draft guidance follows a previous draft published by the National Institute for Health and Clinical Excellence (NICE) on June 2, which recommended both thalidomide (Thalomid) and Velcade (bortezomib) as first line treatments for multiple myeloma patients ineligible for stem cell transplant or high-dose chemotherapy.

NICE’s most recent draft states that the clinical effectiveness of Velcade and thalidomide are comparable, yet designated Velcade as a backup treatment to thalidomide after analyzing the costs of the two treatments.

These recommendations followed consultations with a number of government, patient, and professional multiple myeloma organizations. Determinations of cost effectiveness were made based on reports submitted by Janssen-Cilag, the distributor of Velcade in the U.K., and Celgene, the manufacturer of thalidomide.

The statements presented in the draft have raised concerns at Janssen-Cilag about the accessibility of Velcade as first-line treatment for multiple myeloma patients in the U.K. The company said in a statement that it will appeal against NICE’s recommendations.

The appeal period for this draft will close on September 10, and a final guidance is expected to be published by NICE later that month.

Both drugs are currently recommended as second-line treatments for the treatment of multiple myeloma.

More information about the draft can be found at the NICE website.