Thank you Roger, I've been wanting to make a similar point for a long time. It's a horrible gamble we have to take here, because as we all know here, lives are being lost and suffering and iatrogenic harm continues while the current guidelines remain in place. However, after the next review, whether it's in 2017 or later, how long after that will it be until the next review? And regardless of the real strength of the evidence, given what we know about NICE's values, how do we think they will assess the existing evidence if they reassess the guidelines some time in 2017?
My instinct on that calculation is perhaps a bit conservative, but I would personally want to wait until the Rituximab Phase 3 trial has been published in early 2018, and have NICE look at everything soon after that, because I think that will be a total game-changer. I also want to wait until there is as much peer-reviewed publication as possible re-analysing PACE based on the recently released data, because they can and will ignore the existing re-analysis because it's not on their radar as far as 'publication' is concerned (however brainless their 'evidence-based' approach may be).
I think the timing is key here. We have some really strong evidence on our side right now, but that evidence is set to reach standards that even NICE will find impossible to ignore within the next year or so. I'd hate to see them get away with ignoring it based on stuff like 'only one phase 2 trial' and 'not peer-reviewed' for the want of another 6 months of waiting - especially if we then have to wait another 5 or 10 years for the next re-assessment.
It's disgusting to be in this situation, because we know the kind of suffering that continues while we wait for a change in the status quo. But my feeling is that around about mid-to-late 2018 is going to be a much better time to require NICE to examine the evidence: with everything we have to present to them by then, I think the case will be so strong that I don't see how they'll be able to ignore it, whereas right now, I can see all too easily how they could brush it all under the carpet again.
