netFormulary South East London Joint Medicines Formulary NHS
Guy's and St Thomas' NHS Foundation Trust
Kings College Hospital NHS Foundation Trust
Lewisham and Greenwich NHS Trust
 
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 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
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 - USE UNDER SPECIALIST SUPERVISION ONLY
Abatacept injection

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Formulary
High Cost Medicine
Red
Approved as per NICE technology appraisal guidance

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 injection (rheumatology indications)

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Formulary
High Cost Medicine
Red
Approved as per NICE technology appraisal guidance

Link  NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
Link  NICE TA199: Etanercept, infliximab and adalimumab for the treatment of psoriatic 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
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis    
Baricitinib tabs

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Formulary
High Cost Medicine
Red
Approved as per NICE technology appraisal guidance

Link  NICE TA466: Baricitinib for moderate to severe rheumatoid arthritis    
Belimumab injection

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Restricted Drug Restricted
High Cost Medicine
Red
Approved as per NICE technology appraisal guidance

Lupus Consultants only

Blueteq prior approval required

Link  NICE TA397: Belimumab for treating active autoantibody-positive systemic lupus erythematosus    
Certolizumab pegol injection

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Formulary
High Cost Medicine
Red
Approved for use as per NICE technology appraisal guidance

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 TA415: Certolizumab pegol for treating rheumatoid arthritis after inadequate response to a TNF-alpha inhibitor
Link  NICE TA445: Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs    
Etanercept injection (rheumatology indications)

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Formulary
High Cost Medicine
Red
Approved as per NICE technology appraisal guidance

Biosimilar products available, to be prescribed by brand name. Contact pharmacy department for advice on brand for routine prescribing if unsure

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
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis    
Golimumab injection (rheumatology indications)

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Formulary
High Cost Medicine
Red
Approved as per NICE technology appraisal guidance

Link  NICE TA220: Psoriatic arthritis - golimumab
Link  NICE TA225: Rheumatoid arthritis - golimumab
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 injection (licensed rheumatology indications)

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Formulary
High Cost Medicine
Red
Approved as per NICE technology appraisal guidance

Biosimilar products available, to be prescribed by brand name. Contact pharmacy department for advice on brand for routine prescribing if unsure

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
Link  SE London APC position statement: Biosimilar infliximab    
Rituximab injection (rheumatology - licensed indications)

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Formulary
High Cost Medicine
Red
Approved as per NICE technology appraisal guidance below

Biosimilar products available, to be prescribed by brand name. Contact pharmacy department for advice on brand for routine prescribing if unsure

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    
Sarilumab pre-filled pen or syringe

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Formulary
Red
Approved as per NICE Technology Appraisal guidance

Link  NICE TA485: Sarilumab for moderate to severe rheumatoid arthritis    
Secukinumab injection (ankylosing spondylitis & psoriatic arthritis)

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Formulary
High Cost Medicine
Red
Approved as per NICE technology appraisal guidance

Link  NICE TA407: Secukinumab for active ankylosing spondylitis after treatment with non-steroidal anti-inflammatory drugs or TNF-alpha inhibitors
Link  NICE TA445: Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs    
Tocilizumab injection (arthritis)

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Formulary
High Cost Medicine
Red
Approved as per NICE technology appraisal guidance

Link  NICE TA238: Arthritis (juvenile idiopathic, systemic) - tocilizumab
Link  NICE TA247: Rheumatoid arthritis - tocilizumab (rapid review 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    
Tofacitinib tabs

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Formulary
High Cost Medicine
Red
Approved as per NICE technology appraisal guidance

Link  NICE TA480: Tofacitinib for moderate to severe rheumatoid arthritis    
Ustekinumab injection (psoriatic arthritis)

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Formulary
High Cost Medicine
Red
Approved as per NICE technology appraisal guidance

Link  NICE TA340: Ustekinumab for treating active psoriatic arthritis    
Infliximab injection (rheumatology off-label indications)

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Restricted Drug Restricted
High Cost Medicine
Red
Approved off-label indication:
Severe refractory Behcet's disease including pulmonary and peripheral arterial aneurysms

Restricted to Lupus Consultants in collaboration with a Respiratory Consultant

Biosimilar products available, to be prescribed by brand name. Contact pharmacy department for advice on brand for routine prescribing if unsure

Link  SE London APC position statement: Biosimilar infliximab    
Rituximab injection (rheumatology - off-label indications)

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Restricted Drug Restricted
High Cost Medicine
Red
Approved off-label indications:
Treatment of resistant acute autoimmune connective tissue disorders (CTDs) such as:
  • Systemic lupus erythematosus (SLE)
  • Inflammatory myopathies
  • Sjogren’s syndrome
  • Systemic vasculitides
  • IgG4-related disease (as per NHSE Policy 16057/P)

    Restricted to Lupus Consultants only
    Reserved for patients with severe active autoimmune diseases that have failed to respond to or are intolerant of at least two immunosuppressants (azathioprine, methotrexate, mycophenolate or cyclophosphamide), each having been taken for at least three months

    Biosimilar products available, to be prescribed by brand name. Contact pharmacy department for advice on brand for routine prescribing if unsure

  • Link  NHSE 16057/P: Rituximab for IgG4-related disease    
    Tocilizumab injection (Takayasu arteritis)

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    Formulary
    High Cost Medicine
    Red
    Approved off-label indication:
    For Takayasu arteritis, as per criteria in NHSE commissioning policy 16056/P

    Link  NHSE 16056/P: Tocilizumab for Takayasu arteritis (adults)    
    10.01.03  Expand sub section  Sulfasalazine
     ....
    Key
    note Notes First Choice Item First Choice item
    Section Title Section Title (top level) Non Formulary Item Non Formulary section
    Section Title Section Title (sub level)
    Cytotoxic Drug
    Cytotoxic Drug
    Restricted Drug
    Restricted Drug
    CD
    Controlled Drug
    Unlicensed Drug
    Unlicensed
    High Cost Medicine
    High Cost Medicine
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    Link to SPCs
    click to search medicines.org.uk
    Link to adult BNF
    Track Changes
    Display tracking information
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    Cancer Drugs Fund
    Cancer Drugs Fund
       

     

    Traffic Light Status Information

    Status Description
      Red   Specialist Prescribing only. The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist. In very exceptional circumstances a specialist may discuss individual patient need for a RED drug to be prescribed by a GP and the GP should consider informing the Medicines Management team before a decision is made to prescribe for individual patients.   
      Amber 1   Treatment can be initiated in primary care after a recommendation from an appropriate specialist  
      Amber 2   Specialist initiation followed by maintenance prescribing in primary care  
      Amber 3   Specialist initiation with ongoing monitoring required. After dose stabilisation GPs can be requested to take over prescribing responsibilities using the approved APC shared care documentation  
      Green   Specialist and non-specialist initiation  
      Grey   Not recommended for prescribing  

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