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
Notes:

Where a formulary entry does not detail a medicine’s indications for use, the medicine can be assumed to be approved for all licensed indications.

Formulary approved "off-label" use is detailed separately.

 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 - USE UNDER SPECIALIST SUPERVISION ONLY
Abatacept injection
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Formulary
Red
High Cost Medicine
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)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
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
Red
High Cost Medicine
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
Red
High Cost Medicine
BlueTeq

Approved as per NICE technology appraisal guidance

Lupus Consultants only 

 
Link  NICE TA397: Belimumab for treating active autoantibody-positive systemic lupus erythematosus
   
Certolizumab pegol injection
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Formulary
Red
High Cost Medicine
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
Red
High Cost Medicine

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
Red
High Cost Medicine
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
Link  NICE TA497: Golimumab for treating non-radiographic axial spondyloarthritis
   
Infliximab injection (licensed rheumatology indications)
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Formulary
Red
High Cost Medicine

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 (ANCA vasculitis)
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Formulary
Red
High Cost Medicine
BlueTeq

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 TA308: Rituximab in combination with glucocorticoids for treating anti-neutrophil cytoplasmic antibody-associated vasculitis
   
Rituximab injection (rheumatology - licensed indications)
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Formulary
Red
High Cost Medicine

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
   
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
Red
High Cost Medicine
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 (Adult-Onset Still's Disease )
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Formulary
Red
High Cost Medicine
BlueTeq

Approved for use as per NHSE policy criteria (see link below)

Note: Anakinra and Tocilizumab cannot be used concurrently

 
Link  Clinical Commissioning Policy: Anakinra/tocilizumab for the treatment of Adult-Onset Stillís Disease refractory to second-line therapy (adults) (170056P)
   
Tocilizumab injection (arthritis)
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Formulary
Red
High Cost Medicine
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
   
Tocilizumab subcutaneous injection (giant cell arteritis)
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Formulary
Red

Approved as per NICE technology appraisal guidance

 
Link  NICE TA518: Tocilizumab for treating giant cell arteritis
   
Tofacitinib tabs
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
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
Red
High Cost Medicine
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
Red
High Cost Medicine

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
Red
High Cost Medicine
BlueTeq

Approved off-label indications:

Treatment of resistant acute autoimmune connective tissue disorders (CTDs) such as:

  • Systemic lupus erythematosus (SLE) - Blueteq application required
  • 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 -off-label)
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Formulary
Red
High Cost Medicine

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
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
click to search medicines.org.uk
Link to adult 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

Specialist or hospital prescribing only. The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist or hospital. 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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