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Hot off the breath
Omalizumab: NICE to USE you, to LOSE you NICE
  1. Andy Bush1,
  2. Ian D Pavord2
  1. 1Imperial College & Royal Brompton & Harefield NHS Foundation Trust, London, UK
  2. 2Department of Respiratory Medicine, Allergy and Thoracic Surgery, Institute for Lung Health, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
  1. Correspondence to Professor Andy Bush, Department of Paediatric Respiratory Medicine, Imperial College & Royal Brompton & Harefield NHS Q6 Foundation Trust, London, UK; A.Bush{at}

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National Institute for Health and Clinical Excellence (NICE) has just published draft recommendations for the use of omalizumab. These are as follows:

  1. Omalizumab is not recommended within its marketing authorisation for treating severe persistent allergic asthma

  2. People currently taking omalizumab should be able to continue treatment until they and their clinician consider it appropriate to stop. For children and adolescents, this decision should be made jointly by the clinician, the child or adolescent, and their parents or carers.

Clearly this blanket recommendation does not merely touch the confines of lunacy, but goes well beyond. Those who try to plough through NICE's obfuscatory documents would empathise with God's question to Job: Who is this that darkens counsel by words without knowledge?

However, it is facile solely to blame NICE for these ridiculous proposals; guilt must also be shared by doctors and the industry. The purpose of this annotation is not just to indulge in mere vulgar abuse of NICE, agreeable though this pastime may be, but to try at the 59th minute of the 11th hour to propose a way of salvaging something from the impending wreck. We propose a way forward which, since it will not please everyone, will in the best traditions of family life, annoy everyone hopefully equally.

It is common ground that (a) most patients with asthma can have their disease controlled with properly administered low to moderate doses of inhaled corticosteroids, sometimes supplemented by an …

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  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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