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Bedfordshire and Luton Joint Formulary
Bedford Hospital NHS Trust
Bedfordshire CCG
Luton & Dunstable University Hospital NHS Foundation Trust
Luton CCG
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 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
Notes:

Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing

 Details...
10.01.03  Expand sub section  Drugs which suppress the rheumatic disease process
10.01.03  Expand sub section  Gold
10.01.03  Expand sub section  Penicillamine
10.01.03  Expand sub section  Antimalarials
10.01.03  Expand sub section  Drugs affecting the immune response to top
10.01.03  Expand sub section  Cytokine modulators
Abatacept (Orencia®)
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Restricted Drug Restricted
Red
High Cost Medicine
FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.

125mg Pre-filled Syringe OR pen for sub-cutaneous injection.
250mg injection for IV infusion.

Must be prescribed by a Rheumatology consultant in accordance with NICE TA373 & TA375 for the treatment of rheumatoid and juvenile arthritis.

 
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
Link  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 40mg (Humira®)
(Rheumatology)
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Restricted Drug Restricted
Red
High Cost Medicine

Not for new patients - use Imraldi.

FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.

Must only be prescribed by Rheumatology Consultant in accordance with NICE TA195 and TA375 for the treatment of rheumatoid arthritis.

 
Link  NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
Link  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 40mg (Imraldi®)
(Rheumatology)
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Restricted Drug Restricted
Red

New biosimilar brand for all new patients

FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.

Must only be prescribed by Rheumatology Consultant in accordance with NICE TA195 and TA375 for the treatment of rheumatoid arthritis.

See NICE TA's above

 
   
Certolizumab Pegol 200mg (Cimzia®)
(Injection , pre-filled pen or syringe)
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Restricted Drug Restricted
Red
High Cost Medicine
FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.

Must be prescribed by a Rheumatology consultant in accordance with NICE TA375, TA383 or TA445.



 
Link  MHRA Drug Safety Update (April 2014) - Tumour necrosis factor alpha inhibitors
Link  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
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
Link  NICE TA445: Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs
   
Etanercept (Benepali®, Enbrel®)
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Restricted Drug Restricted
Red
High Cost Medicine
FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.
Must be prescribed by Consultant Rheumatologist in accordance with NICE TA199, TA383, TA375.

10mg/mL, 25mg/1mL & 50mg/1mL Injection
50mg/1mL Pre-filled Syringe or pen

NOTE:
ALL prescribing of etanercept must be by brand name.
Benepali® is first choice etanercept preparation for the treatment of patients greater than 18 years with rheumatoid arthritis (NICE TA199/375), psoriatic arthritis (NICE TA199) and ankylosing spondylitis (NICE TA383)
Enbrel® is the treatment of choice for initiation in patients who are less than 18 years of age, those with juvenile idiopathic arthritis (JIA) and those requiring a dose of 25mg

See section 13.05.03 (for Dermatology)


 
Link  NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
Link  NICE TA199: Psoriatic arthritis - etanercept, infliximab and adalimumab
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
Link  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
   
Golimumab 50mg, 100mg (Simponi®)
(Injection, pre-filled pen or syringe)
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Restricted Drug Restricted
Red
High Cost Medicine

FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.

Must be prescribed by a Consultant Rheumatologist in accordance with NICE TA's below.

 
Link  MHRA Drug Safety Update (April 2014) - Tumour necrosis factor alpha inhibitors
Link  NICE TA220: Psoriatic arthritis - golimumab
Link  NICE TA225: Rheumatoid arthritis - golimumab
Link  NICE TA233: Ankylosing spondylitis - golimumab
Link  NICE TA497: Golimumab for treating non-radiographic axial spondyloarthritis
   
Infliximab 100mg (Remsima®, Remicade®)
(Intravenous infusion)
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Restricted Drug Restricted
Red
High Cost Medicine
FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.

Must be prescribed by a Rheumatology Consultant in accordance with NICE TA195, TA199, TA375 & TA383 for the treatment of rheumatoid arthiritis and severe active ankylosing spondylitis.
NOTE:
ALL prescribing of infliximab must be by brand name.
Remsima® is first choice infliximab biosimilar for all new patients.
Infliximab biosimilar may be prescribed for patients currently receiving Remicade® brand when considered clinically appropriate by the relevant consultant and with consent of the patient

See Section 1.5.3 (for Gastroenterology) and 13.5.3 (for Dermatology)  
Link  NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
Link  NICE TA199: Psoriatic arthritis - etanercept, infliximab and adalimumab
Link  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
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
   
Rituximab 500mg/50mL (MabThera®)
(Intravenous infusion)
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Restricted Drug Restricted
Red
High Cost Medicine
FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.

Must be prescribed by Rheumatology Consultant in accordance with NICE TA308 & TA195 for the treatment of rheumatoid arthritis and anti-neutrophil cytoplasmic antibody-associated vasculitis.

see Section 8.2.3 (for Haematology)

 
Link  NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
Link  NICE TA308: Rituximab in combination with glucocorticoids for treating anti-neutrophil cytoplasmic antibody-associated vasculitis
   
Secukinumab 150mg (Cosentyx®)
(Pre-filled pen or syringe)
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Restricted Drug Restricted
Red
High Cost Medicine

FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.

Restricted to prescribing by Consultant Rheumatologist for the treatment of ankylosing spondylitis in accordance with NICE TA407.

 
Link  NICE TA407: Secukinumab for active ankylosing spondylitis after treatment with NSAIDs or TNF-alpha inhibitors
   
Tocilizumab (RoActemra®)
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Restricted Drug Restricted
Red
High Cost Medicine

FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.

162mg pre-filled syringe for subcutaneous injection
80mg, 200mg, 400mg solution for intravenous infusion

Must be prescribed by a Rheumatology consultant in accordance with the NICE TA's below.

 
Link  NICE TA238: Arthritis (juvenile idiopathic, systemic) - tocilizumab
Link  NICE TA247: Rheumatoid arthritis - tocilizumab (rapid review TA198)
Link  NICE TA518: Tocilizumab for treating giant cell arteritis
   
Ustekinumab 45mg, 90mg (Stelara®)
(Pre-filled syringe)
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Restricted Drug Restricted
Red
High Cost Medicine
FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.

Restricted to prescribing by Consultant Rheumatologist for the treatment of active psoriatic arthritis in accordance with NICE TA340. 
Link  MHRA Drug Safety Update (Jan 15): (Stelara®) - risk of exfoliative dermatitis
Link  NICE TA340 - treating active psoriatic arthritis
   
10.01.03  Expand sub section  Sulfasalazine
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
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Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

RED - Hospital only – to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment  

Amber

Amber medicines are considered suitable for GP prescribing following specialist initiation.  

Green

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations   

Amber SCG

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.   

Black

A decision has been made by either or both the local or national NHS not to routinely commission this preparation for its licensed indications. Do not prescribe.   

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