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Welcome to September's edition of Tablets, a prescribing newsletter produced monthly by the Medicines Management team at Midlands and Lancashire CSU.
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New medicines
RED Budesonide orodispersible tablets (Jorveza®▼) for inducing remission of eosinophilic oesophagitis in adults
Red statement in line with NICE TA708 that recommends budesonide orodispersible tables for up to 12 weeks for inducing remission of eosinophilic oesophagitis only. NICE did not consider maintenance treatment. All prescribing and monitoring should retained by the specialist. NICE do not expect a significant resource impact. Cost of 12 week course is £602 at NHS list price.
RED GUSELKUMAB injection (Tremfya®▼) for psoriatic arthritis
Red statement in line with NICE TA711 that recommends guselkumab, with or without methotrexate, as an option for treating active psoriatic arthritis in adults who have not responded well enough to, or cannot tolerate, DMARDs provided specific criteria are met and it is provided at the PAS discount.
PBR excluded high cost drug. NICE does not expect this guidance to have a significant impact on resources. This is because guselkumab is a further treatment option available at a similar price to the current treatment options.
RED Adalimumab, etanercept, infliximab and abatacept for moderate rheumatoid arthritis
Red statement in line with NICE TA715 that recommends adalimumab, etanercept and infliximab, for use by specialists only, in the treatment of moderate rheumatoid arthritis (RA) after conventional DMARDs have failed. Abatacept is not recommended for moderate RA.
PBR excluded high cost drugs. NICE estimates the additional resource impact of implementing this guidance for this new cohort of patients as £28,000 per 100,000 population in 2021/22, rising to £67,000 per 100,000 in 2023/24, when steady state is assumed to have been reached.
GREY INCLISIRAN solution for injection (Leqvio ®▼) for primary hypercholesterolaemia or mixed dyslipidaemia
Not recommended until NICE TA published.
Formulary and guidelines
GREEN Dulaglutide in type 2 diabetes
Addition of dulaglutide injection (pre-filled pen) 3 mg and 4.5 mg to formulary, alongside current 0.75 mg and 1.5 mg. Higher doses offer greater glucose lowering and weight loss efficacy and cost is identical to lower dose.
LACTOSE INTOLERANCE AND COWS’ MILK PROTEIN ALLERGY – Prescribing Guidelines for Specialist Infant Formula Feeds
Update of the current Pan Mersey guideline. Numerous detail changes made. Re-written referral pathways and local access to feeding clinic and specialist dieticians to reflect variation across the Pan Mersey region.
Shared Care
AMBER INITIATED Oestradiol for patients attending CMAGIC
AMBER INITIATED Testosterone for patients attending CMAGIC
AMBER INITIATED Gonadorelin analogues for patients attending CMAGIC
New prescribing support information to support prescribing for patients attending the Cheshire and Merseyside Gender Identity Collaborative (CMAGIC). It will also support GPs who are already prescribing treatment for gender incongruence.
AMBER INITIATED Low molecular weight heparin (LMWH) for adults
Routine review of the existing prescribing support information and a new GP letter. There is a new section on page 3 detailing the responsibilities for the specialist initiating treatment. Monitoring now sits with the prescriber with the exception of anti-factor Xa.
Antimicrobials
Suspected meningococcal disease
Updated guidance emphasises transfer to hospital and removes cefotaxime as an alternative to benzylpenicillin.
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Please click here for a full summary of safety updates and SPC updates in August.
Maxtrex (methotrexate)
06 August 2021
The healthcare professionals guide contains information on how to minimise risk of overdose from patients incorrectly taking methotrexate daily instead of weekly for autoimmune diseases. Patients should be advised to write treatment day on the accompanying Patient Reminder Card.
Safety of medicines in porphyria
09 August 2021
This series of articles describes the different types of porphyria. Some medicines can precipitate a painful acute attack and this resource aims to help clinicians making safer medicine choices for individuals with this condition.
Clexane ® (enoxaparin sodium) device – Important Information regarding differences between PREVENTIS and ERIS needle guard safety systems
13 August 2021
From August 2021, Clexane pre-filled syringes with both ERIS and PREVENTIS safety systems will be in the supply chain simultaneously. This healthcare professional communication highlights the differences in the needle guard safety systems between the two devices.
Potent Synthetic Opioids Implicated In Increase In Drug Overdoses
18 August 2021
In past 2 weeks there have been unprecedented number of overdoses (some deaths) in drug users, primarily of heroin, in some parts of country. Testing in 3 cases indicate adulteration with isotonitazene, a potent synthetic opioid. Alert contains urgent actions for providers.
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NICE Guidelines July 2021
There are two guidelines, four technology appraisals and one COVID-19 rapid guideline published in July 2021 by the National Institute for Clinical Excellence which has impact upon primary care.
The COVID-19 rapid guideline: vaccine-induced immune thrombocytopenia and thrombosis (VITT) guideline has been published. The guideline was produced the support clinicians to diagnose and manage this newly recognised syndrome, which has been reported in rare cases after COVID-19 vaccination.
The Type 1 diabetes in adults: diagnosis and management guideline has been updated. The guideline has been updated to amend the recommendations on long-acting insulin therapy.
The Clostridioides difficile infection: antimicrobial prescribing guideline has been published. It sets out an antimicrobial prescribing strategy for managing the infection in adults, young people and children aged 72 hours and over in community and hospital settings. The guideline aims to optimise antibiotic use and reduce antibiotic resistance.
The Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation technology appraisal has been updated. This update amended recommendation 1.2 to include consideration of the risks and benefits of this and other anticoagulants approved by NICE.
The Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation technology appraisal has been updated. This update amended recommendation 1.2 to include consideration of the risks and benefits of this and other anticoagulants approved by NICE.
The Apixaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation technology appraisal has been updated. This update amended recommendation 1.2 to include consideration of the risks and benefits of this and other anticoagulants approved by NICE.
The Edoxaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation technology appraisal has been updated. This update amended recommendation 1.2 to include consideration of the risks and benefits of this and other anticoagulants approved by NICE.
Clinicians should be aware of this guideline and implement any necessary changes to their practice.
CKS Updates July 2021
During the month of July 2021, the following Clinical Knowledge Summaries were published or updated:
All the above topics have been reviewed and updated in line with NICE guidance with minor layout changes. The two contraception topics have been updated to remove Quality and Outcomes Framework (QOF) indicators.
Clinicians can use the updated and new information when reviewing patients.
NICE Guidelines August 2021
There have been five guidelines and one COVID-19 rapid guideline published in August 2021 by the National Institute for Clinical Excellence which has impact upon primary care.
The COVID-19 rapid guideline: managing COVID-19 has been updated. The update corrects an error in the recommended dose of prednisolone for children with a greater than 44-week corrected gestational age.
The Antenatal care guideline has been published. The guideline covers the routine antenatal care that women and babies should receive. It also aims to ensure pregnant women are offered regular check-ups, information, and support.
The Bronchiolitis in children: diagnosis and management guideline has been updated. The guideline has updated the recommendations on oxygen saturation thresholds for referral to hospital.
The Babies, children and young people’s experience of healthcare guideline has been published. The guideline aims to make sure all babies, children and young people using NHS services have the best possible experience of care.
The Chronic kidney disease: assessment and management guideline has been published. It covers care and treatment for people with, or at risk of, chronic kidney disease (CKD).
The Obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s guideline has been published. It aims to improve recognition, investigation, and treatment of these related conditions.
Clinicians should be aware of this guideline and implement any necessary changes to their practice.
CKS Updates August 2021
During the month of August 2021, the following Clinical Knowledge Summaries were published or updated:
All the above topics have been reviewed and updated in line with NICE guidance with minor layout changes. The Carpal tunnel syndrome recommendations on follow up in primary care have been amended. The Haemorrhoids topic has been updated to recommend topical preparations for haemorrhoids which should be purchased over the counter in line with NHS Clinical Commissioners (2018).
Clinicians can use the updated and new information when reviewing patients.
The information in the Prescribing News section has been adapted from the Prescribing Advice for GPs blog
This section has been adapted from www.prescriber.org.uk
Useful Resources
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