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Welcome to the November edition of Tablets, a prescribing newsletter produced monthly by the Medicines Management team at Midlands and Lancashire CSU.
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Recommendations
RED ABROCITINIB tablets (Cibinqo®▼), TRALOKINUMAB injection (Adtralza®▼) or UPADACITINIB prolonged-release tablets (Rinvoq®▼) for treating moderate to severe atopic dermatitis
Tariff-excluded high cost drugs for specialist use only. The local cost of implementing this guidance is estimated to be £44,000 per 100,000 population in 2022/23, rising to £61,000 per 100,000 by 2026/27 when steady state is assumed to have been reached. This is based on the NHS list price but the resource impact will be less once the PAS discounts are applied.
RED BROLUCIZUMAB injection (Beovu®▼) for diabetic macular oedema
Tariff-excluded high cost drug for specialist use only. No significant cost impact is expected because brolucizumab is a further treatment option available at a similar price to the current treatment options.
RED GUSELKUMAB injection (Tremfya®▼) for psoriatic arthritis
This update allows people who have previously received a biologic treatment and people who have contraindications to TNF-alpha inhibitors to access guselkumab. Tariff-excluded high cost drug for specialist use only. No significant cost impact is anticipated because guselkumab is a further treatment option available at a similar price to the current treatment options.
RED ROXADUSTAT film coated tablets (Evrenzo®▼) for treating symptomatic anaemia in chronic kidney disease
Tariff-excluded high cost drug for specialist use only. The cost of implementing this guidance is estimated to be £3,000 per 100,000 population in 2022/23, rising to £8,000 per 100,000 population in 2024/25 when steady state is assumed to have been reached. This is based on the NHS list price but the resource impact will be less once the PAS discount is applied.
GREEN ICOSAPENT ETHYL capsules (Vazkepa®▼) with statin therapy for reducing the risk of cardiovascular events in people with raised triglycerides
Icosapent ethyl can be initiated in both primary and secondary care but NICE expects that the majority of prescribing will take place in primary care. The estimated cost of implementing this guidance is £12,000 per 100,000 population in 2022/23, rising to £51,000 per 100,000 population by 2026/27 when it is assumed that steady state has been reached.
GREY BARICITINIB tablets (Olumiant®) for alopecia areata
Not recommended until NICE TA published.
GREY UPADACITINIB prolonged-release tablets (Rinvoq®▼) for non-radiographic axial spondyloarthritis
Not recommended until NICE TA published.
Formulary & Guidelines
RED Inflammatory bowel disease guidelines
Minor update to include filgotinib, in line with NICE TA792 and ozanimod, in line with NICE TA828 for patients with moderately to severely active ulcerative colitis.
RED Methadone RAG rating
The addition of a Red RAG designation for methadone, when used to treat patients with pain who are under the care of palliative services to provide clarification.
RED Paliperidone 6-monthly injection
Addition of Paliperidone palmitate - prolonged-release suspension for injection 700mg, 1000mg (6-month depot) to formulary section 4.2.2, designated Red. This is an addition to existing range of 1-month and 3-month depot injections.
AMBER INITIATED Melatonin statement, flowchart and prescribing support information
Patients with Parkinson's disease do not require referral to a separate sleep service when treatment commenced by neurologist. Other forms of licensed melatonin such as melatonin 2mg capsules (Colonis®), melatonin 3mg tablets (Colonis®) or melatonin 1mg/ml liquid (Colonis®) which are licensed in jet lag for short term use have red designation. Additional information on melatonin "holidays".
GREEN Metformin use in T1 diabetes
This is an off‑label indication recommended by NICE [NG17] for adults with type 1 diabetes who have a BMI of 25 kg/m2 or above (23 kg/m2 or above for people from South Asian and related family backgrounds) who wish to improve their blood glucose control while minimising their effective insulin dose.
GREEN Doublebase Once Emollient Gel
Replaces Doublebase Dayleve Gel. The cost is slightly more per container, but it is applied once daily instead of twice daily and so will be less expensive.
GREEN SGLT2 inhibitors to treat type 2 diabetes
Update in line with NICE NG28 where these are now recommended in addition to first-line metformin for adults who have type 2 diabetes and other specified comorbidities, or first-line in these patients if metformin is contraindicated or not tolerated.
Opioids and Gabapentinoids for chronic pain in adults
Minor update to include reference to NICE NG215.
Other Business
Consensus on the Primary and Secondary Care Interface
Document published by NHS Cheshire and Merseyside in June 2022. For dissemination within organisations as appropriate.
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Please click here for a full summary of safety updates and SPC updates in October.
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