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Herefordshire & Worcestershire
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 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
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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
Cytotoxic Drug Methotrexate Tablets
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Amber with Shared Care

Only 2.5mg tablets should be prescribed and dispensed to avoid potentially fatal errors.

 
Link  Drug Safety Update (Sept 20): Methotrexate once-weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly dosing
 
Cytotoxic Drug Methotrexate subcutaneous Injection (Metoject)
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Amber with Shared Care
 
 
Abatacept
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Red

Commissioned by CCGs in line with NICE TA195 (Update of TA36, 126 and 141) and TA375 (replaces TA280)
Subcutaneous abatacept has been approved for its licensed indications in line with NICE criteria for intravenous abatacept
 
In line with NICE TA373-(Commissioned by NHS England)
people 6 years and older whose disease has responded inadequately to other disease-modifying anti-rheumatic drugs (DMARDs) including at least 1 tumour necrosis factor (TNF) inhibitor.


Funded by NHS England when used for Paediatric Indications where Adult NICE TAs exist.

 
Link  NICE TA195 Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
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
 
Azathioprine
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Amber with Shared Care
 
 
Baricitinib
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Red

In line with NICE TA466

 
Link  MHRA Drug Safety Update (Aug 20): Baricitinib (Olumiant▼): increased risk of diverticulitis, particularly in patients with risk factors
Link  MHRA Drug Safety Update (Mar20): Baricitinib (Olumiant▼): risk of venous thromboembolism
Link  NICE TA466
 
Certolizumab Pegol
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Red

In line with NICE TA375, TA383 and TA415

 
Link  NICE 415 Certolizumab pegol for treating rheumatoid arthritis after inadequate response to a TNF-alpha 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
Link  NICE TA383 TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
 
Ciclosporin
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Amber

For skin conditions to be initiated by Consultant Dermatologist or GPSI but GPs may continue.
For use post transplant see section 8.2.2

 
 
Etanercept
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Red

Biosimilar etanercept is available on the formulary in line with its licence.

CCGs commission in line with NICE TA35, TA36, TA103, TA195 (Update of TA36, 126 and 141),TA199(Update of TA 104), TA373, TA375 and TA383 (replaces TA143)

Paediatric use commissioned by NHS England
 

 
Link  NICE TA195
Link  NICE TA199
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
Link  NICE TA383 TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
 
Golimumab
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Red

In line with NICE TAs 220, 225, 233, 329,375 (Guidance replaces NICE TA224 and partially updates TA225)
and TA383 (Guidance replaces NICE TA233)

 
Link  NICE TA220 Golimumab for the treatment of psoriatic arthritis
Link  NICE TA225 Golimumab for the treatment of rheumatoid arthritis after the failure of previous disease-modifying anti-rheumatic drugs
Link  NICE TA329 Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy
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
 
Infliximab
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Red

In line with NICE TA134, TA195 (Update of TA36, 126 and 141),TA199, 329,TA375 (replaces NICE TA130) and TA383 (replaces NICE TA143)


 
Link  NICE TA134 Infliximab for the treatment of adults with psoriasis
Link  NICE TA195 Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
Link  NICE TA199 Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis
Link  NICE TA329 Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy
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
 
Leflunomide
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Amber with Shared Care
 
 
Rituximab
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Red

Commissioned by CCG for Rheumatological conditions in line with NICE TA195 (Update of TA36, 126 and 141) and TA 308.

For anti-TNF treatment failure patients only; specialist rheumatologist only.
 
 Commissioned by NHS England for ITP.

 
Link  NICE TA 308 Rituximab in combination with glucocorticoids for treating anti-neutrophil cytoplasmic antibody-associated vasculitis
Link  NICE TA195 Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
 
Sarilumab
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Red

In line with NICE TA485

 
Link  NICE TA485
 
Tocilizumab
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Red

In line with NICE TA 238, 247(Replaced TA 198) and 375


Subcutaneous tocilizumab was approved for patients who fall in line with NICE TA 247 or the prescribing committee approved indication as monotherapy in case of intolerance to methotrexate or where continued treatment with methotrexate is inappropriate.
 
In line with NICE TA373-Commissioned by NHS England
people 2 years and older whose disease has responded inadequately to previous therapy with methotrexate.
 
In line with NICE TA375 (partially updates NICE TA247)

 
Link  MHRA Drug Safety Update (Jul 19): Tocilizumab (RoActemra): rare risk of serious liver injury including cases requiring transplantation
Link  NICE TA238 Tocilizumab for the treatment of systemic juvenile idiopathic arthritis
Link  NICE TA247 Tocilizumab for the treatment of rheumatoid arthritis (updates and replaces ta198)
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
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Red

In Line With NICE TA143, TA146, TA195 (Update of TA36, 126 and 141), TA199 (Update of TA104 and 125) and TA329, TA373, TA375, TA383
  
Use of Adalimumab in Paediatric Uveitis is commissioned by NHS England

 
Link  NICE TA146 Adalimumab for the treatment of adults with psoriasis
Link  NICE TA195 Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
Link  NICE TA199 Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis
Link  NICE TA329 Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy
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
Link  NICE TA383 TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
 
10.01.03  Expand sub section  Sulfasalazine
 ....
 Non Formulary Items
Anakinra  (Kineret)

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Non Formulary

NICE "do not do"

Link  NICE CG79 Rheumatoid arthritis in adults: management
  
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
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Link to children's BNF
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Link to SPCs
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

Secondary care only, not to be prescribed in primary care.   

Amber 2

Specialist initiation with shared care guidance Medicines which should be initiated in secondary care by the specialist with follow-on prescription and monitoring according to a specific Shared Care (SC) Guideline. Prescribing may be continued in primary care in line with a shared care guideline   

Amber with Shared Care

Specialist initiation with shared care guidance Medicines which should be initiated in secondary care by the specialist with follow-on prescription and monitoring according to a specific Shared Care (SC) Guideline. Prescribing may be continued in primary care in line with a shared care guideline   

Amber

Considered suitable for primary care prescribing following specialist initiation/recommendation.  

Green

Considered appropriate for prescribing in both secondary and primary care. Suitable for initiation in primary care.   

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