A Roundup of the Latest Guidance From NICE

Peter Russell

September 07, 2018

Guidance from the National Institute for Health and Care Excellence (NICE) this week included treatment decisions for Hodgkin lymphoma and X-linked hypophosphataemia.

There was also a quality standard for emergency and acute medical care, and clinical guidance on treating and managing pancreatitis.

Pembrolizumab for Hodgkin Lymphoma

In final guidance, NICE rejected the immunotherapy drug pembrolizumab (Keytruda, Merck) for routine NHS use for treating relapsed or refractory classical Hodgkin lymphoma in adults who have had autologous stem cell transplant and brentuximab vedotin.

It decided that there was insufficient evidence to recommend pembrolizumab on grounds of cost-effectiveness above the currently recommended nivolumab (Opdivo, Bristol-Myers Squibb).

However, NICE recommended pembrolizumab for use within England's Cancer Drugs Fund as an option for treating relapsed or refractory classical Hodgkin lymphoma in adults who have had brentuximab vedotin and cannot have autologous stem cell transplant, only if:

  • Pembrolizumab is stopped after 2 years of treatment or earlier if the person has a stem cell transplant or the disease progresses

  • The conditions in the managed access agreement for pembrolizumab are followed

X-linked Hypophosphataemia

A commercial deal persuaded NICE to recommend burosumab (Crysvita, Kyowa Kirin) in final draft guidance as an option for treating X-linked hypophosphataemia (XLH) in children and young people. 

Current treatment for the inherited condition, which includes bowed legs, short stature and bone pain, mainly consists of vitamin D supplementation and oral phosphate.

The annual cost of burosumab, based on its list price, depends on dosage and weight of the child. Estimates range from £77,792 up to £388,960. 

Treatment aims to increase reabsorption of phosphate from the kidney and, through vitamin D production, improve absorption of calcium and phosphate from the digestive system. 

Final guidance is expected in October 2018, and could benefit around 250 children and young people with the condition.

  Emergency and Acute Medical Care

NICE issued a quality standard for the organisation and delivery of emergency and acute medical care in the community and in hospital.


It covered adults, aged 16 and over, who seek, or are referred for, emergency NHS care for a suspected or confirmed acute medical emergency. It described high-quality care in priority areas for improvement.

Areas covered are:

  • Ambulance services

  • Assessment and initial treatment through acute medical units (AMUs)

  • Consultant assessment and review

  • Structured patient handovers

This quality standard is reviewed each year and updated as required.


NICE issued final updated clinical guidance for the treatment and management of pancreatitis.

The guidance includes giving patients, and their family members or carers, information about the condition and its management.

It also covers investigation, treatment and management of complications.


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