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Service in the United Kingdom, recommended thalidomide as a first line of treatment for multiple myeloma patients in a draft guidance published August 26.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This draft guidance follows a previous draft published by the National Institute for Health and Clinical Excellence (NICE) on June 2, which recommended both thalidomide ^[1] (Thalomid) and Velcade ^[2] (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 ^[3] website.