South Staffordshire Joint Formulary Formulary


	South Staffordshire Joint Formulary Cannock Chase Clinical Commissioning Group East Staffordshire Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group

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Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter

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Drugs which suppress the rheumatic disease process

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Gold

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Penicillamine

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Antimalarials

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Drugs affecting the immune response

Methotrexate

Formulary

Methotrexate_Tab 2.5mg

ONLY recommended for GP to prescribe if fully conversant with therapy and can reliably provide the necessary review and monitoring requirement within the context of a Shared Care Arrangement

Prescribe WEEKLY (on the same day each week)as 2.5mg Tablets (Local Agreement)

MHRA/CHM advice: Methotrexate once-weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly dosing (September 2020)

CG79 The Management of Rheumatoid Arthritis in Adults

UKMI Q&A: Methotrexate and alcohol guidance

Azathioprine

Formulary

25mg and 50mg Tablets

ESCA covers rheumatology and gastroenterology patients only

CG79 The Management of Rheumatoid Arthritis in Adults

Ciclosporin

Formulary

Prescribing and dispensing of ciclosporin should be by brand name to avoid inadvertent switching.

25mg, 50mg and 100mg Capsules available in all Brands

10mg Capsules only availble as Neoral

CG79 The Management of Rheumatoid Arthritis in Adults

Leflunomide

Formulary

Leflunomide_Tab 10mg
Leflunomide_Tab 20mg

GP only to continue prescribing where a shared care agreement is provided

CG79 The Management of Rheumatoid Arthritis in Adults

Abatacept (Orencia^®)

Restricted

This is an NHS England Specialised Commissioning Drug for Paediatric Indications (where adult TA available) or Juvenile arthritis

NICE TA195: Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor

NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis

NICE TA375: Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed

Adalimumab (Humira^®)

Restricted

This is a Specialised Drug which would not be routinely commissioned by CCGs for Uveitis or Hidradenitis Suppurativa. This would go through a South Staffs CCGs Individual Funding Request (IFR)

See all NICE Guidance

NICE TA195: Rheumatoid arthritis - drugs for treatment of arthritis after failure of a TNF inhibitor

NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed

NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis

NICE TA373: Juvenile idiopathic arthritis- abatacept, adalimumab, etanercept and tocilizumab

NICE TA392 Adalimumab for treating moderate to severe hidradenitis suppurativa

Apremilast (Otzela®)

Restricted

This is commissioned by CCGs but is a hospital only drug

In Line with NICE guidance

For use in psoriasis click here

NICE TA 433: Apremilast for treating active psoriatic arthritis

Brodalumab

(Kyntheum^®)

Restricted

This is commissioned by CCGs but is a hospital only drug

In line with NICE

NICE TA511: Brodalumab for treating moderate to severe plaque psoriasis

Certolizumab Pegol (Cimzia®)

Restricted

This is a Specialised Drug which would not be routinely commissioned by CCGs for Paediatric Indications. This would go through a South Staffs CCGs Individual Funding Request (IFR)

For adults this is commissioned from CCGs in line with NICE but is hospital only prescribing.

Available via Home Care

NICE TA375: Adalimumab, eternecept, infliximab, certolizumabpegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed

NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis

NICE TA415: Certolizumab pegol for treating rheumatoid arthritis after inadequate response to a TNF-alpha inhibitor

NICE TA445: Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs

NICE TA574: Certolizumab pegol for treating moderate to severe plaque psoriasis

Etanercept (Enbrel^®)

Restricted

This is an NHS England Specialised Commissioning Drug for Paediatric indications (where adult T/A available)
This is an NHS England Specialised Commissioning Drug for Juvenile Arthritis

NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor

NICE TA199: Psoriatic arthritis - etanercept, infliximab and adalimumab

NICE TA373: Juvenile idiopathic arthritis- abatacept, adalimumab, etanercept and tocilizumab

NICE TA383: TNF alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis

NICE TA455: Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people

NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed.

Golimumab (Simponi^®)

Restricted

Commissioned by CCG's

Hospital only

In line with NICE

NICE TA220: Golimumab for the treatment of psoriatic arthritis

NICE TA225: Golimumab for the treatment of rheumatoid arthritis after the failure of previous disease-modifying anti-rheumatic drugs

NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis

NICE TA497: Golimumab for treating non-radiographic axial spondyloarthritis

Infliximab (Remicade^®)

Restricted

This is an NHS England Specialised Commissioning Drug for Paediatric Indications (where adult TA available)

This is an NHS England Specialised Commissioning Drug for Crohn's Disease in Children

This is a Specialised Drug which would not be routinely commissioned by CCGs for Connective tissue disease - interstital lung disease. This would go through a South Staffs CCGs Individual Funding Request (IFR)

This is a Specialised Drug which would not be routinely commissioned by CCGs for Graft versus host disease. This would go through a South Staffs CCGs Individual Funding Request (IFR)

This is a Specialised Drug which would not be routinely commissioned by CCGs for Renal, Sarcoidosis, Uveitis and Hidradenitis Suppurativa. This would go through a South Staffs CCGs Individual Funding Request (IFR)

NICE TA195: Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor

NICE TA199: Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis

NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis

Rituximab (rheumatology) (MabThera^®)

Restricted

This is an NHS England Specialised Commissioning Drug for ANCA-positive vascullitis

This is an NHS England Specialised Commissioning Drug for Paediatric indications (where adult TA available

This is an NHS England Specialised Commissioning Drug for SLE

This is an NHS England Specialised Commissioning Drug for Neuromyelitis optica

This is an NHS England Specialised Commissioning Drug for ABO-incompatible kidney transplants

This is an NHS England Specialised Commissioning Drug for Juvenile arthritis

This is a Specialised Drug which would not be routinely commissioned by CCGs for Haemophilia. This would go through a South Staffs CCGs Individual Funding Request (IFR)

This is a Specialised Drug which would not be routinely commissioned by CCGs for Phemphigus vulgaris. This would go through a South Staffs CCGs Individual Funding Request (IFR)

This is a Specialised Drug which would not be routinely commissioned by CCGs for Connective Tissue Disease - interstitial lung disease. This would go through a South Staffs CCGs Individual Funding Request (IFR)

This is a Specialised Drug which would not be routinely commissioned by CCGs for Graft versus host disease. This would go through a South Staffs CCGs Individual Funding Request (IFR)

This is a Specialised Drug which would not be routinely commissioned by CCGs for Myositis. This would go through a South Staffs CCGs Individual Funding Request (IFR)

This is a Specialised Drug which would not be routinely commissioned by CCGs for Nephritis. This would go through a South Staffs CCGs Individual Funding Request (IFR)

NICE TA195: Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor

NICE TA308: Rituximab in combination with glucocorticoids for treating anti-neutrophil cytoplasmic antibody-associated vasculitis

Sarilumab (Kevzara®)

Restricted

For use in specialist settings only. Commissioned by CCG's

NICE TA485: Sarilumab for moderate to severe rheumatoid arthritis

Tocilizumab (RoActemra^®)

Restricted

This is an NHS England Specialised Commissioning Drug for Paediatric indications (where Adult TA available)

This is an NHS England Specialised Commissioning Drug for Juvenile Arthritis

This is a Specialised Drug which would not be routinely commissioned by CCGs for Large Vessel Vaculitis. This would go through a South Staffs CCGs Individual Funding Request (IFR)

MHRA advice(July 2019): Rare risk of serious liver injury including cases requiring transplantation.

NICE TA238: Tocilizumab for the treatment of systemic juvenile idiopathic arthritis

NICE TA247: Tocilizumab for the treatment of rheumatoid arthritis

NICE TA518: Tocilizumab for treating giant cell arteritis

NICE TA130: Rheumatoid arthritis - adalimumab, etanercept and infliximab

NICE TA143: Ankylosing spondylitis - adalimumab, etanercept and infliximab

NICE TA199: Psoriatic arthritis - etanercept, infliximab and adalimumab (NICE TA199)

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Sulfasalazine

....

Non Formulary Items

Anakinra (Kineret^®)

Non Formulary

This is an NHS England Specialised Commissioning Drug for Juvenile Arthritis

This is an NHS England Specialised Commissioning Drug for Cryoprin Associated Periodic Syndrome

This is a Specialised Drug which would not be routinely commissioned by CCGs for Specialist Autoinflammatory disease or Paediatric indications. This would go through a South Staffs CCGs Individual Funding Request (IFR)

Cyclophosphamide

Non Formulary

Methotrexate (Ebetrex^®)

Non Formulary

Methotrexate (Metoject^®)

Non Formulary

Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to children's BNF
	Link to SPCs
	Scottish Medicines Consortium

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG

Traffic Light Status Information

Status	Description
	Drugs which require special consideration. These are drugs for Consultant Prescribing ONLY. They should not be prescribed in Primary Care.
	Drugs that should be initiated by a Specialist but are suitable for continuation in Primary Care. For some drugs there may be a Ricad in place to aid the transition to primary care.
	Drugs that should be initiated by a Specialist but are suitable for continuation in Primary Care but also require and ESCA (Shared Care Agreement)
	Suitable first-line drugs for implementation in Primary Care
	South Staffs Formulary Choice