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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 13: Skin - Full Chapter
13.05.03  Expand sub section  Drugs affecting the immune response
Adalimumab injection (Hidradenitis suppurativa)

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

Blueteq prior approval required

Link  NICE TA392: Adalimumab for treating moderate to severe hidradenitis suppurativa    
Adalimumab injection (psoriasis)

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

Link  NICE TA146: Adalimumab for the treatment of adults with psoriasis    
Apremilast tabs

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Formulary
High Cost Medicine
Red
Approved for use (as per criteria in NICE guidance) in:
  • Severe to moderate plaque psoriasis (TA419)
  • Active psoriatic arthritis (TA433)

  • Link  MHRA Jan 2017: Apremilast (Otezla ▼): risk of suicidal thoughts and behaviour
    Link  NICE TA419: Apremilast for treating moderate to severe plaque psoriasis
    Link  NICE TA433: Apremilast for treating active psoriatic arthritis    
    Cytotoxic Drug  Azathioprine tabs (immunobullous diseases - off-label)

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    Formulary
    Amber 2
    Approved off-label indication:
    Severe refractory eczema and immunobullous diseases
       
    Ciclosporin caps, oral solution (dermatology indications)

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    Formulary
    Amber 3
    Approved for:
  • Psoriasis
  • Atopic dermatitis
  •    
    Dimethyl fumarate tablets (Skilarence - psoriasis)

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    Formulary
    High Cost Medicine
    Red
    Approved for use in psoriasis as per NICE Technology Appraisal guidance

    Link  NICE TA475: Dimethyl fumarate for treating moderate to severe plaque psoriasis    
    Etanercept injection (psoriasis)

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    Formulary
    High Cost Medicine
    Red
    For severe plaque psoriasis

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

    Link  NICE TA103: Etanercept and efalizumab for the treatment of adults with psoriasis    
    Cytotoxic Drug  Hydroxycarbamide caps (psoriasis - off-label)

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    Formulary
    Red
    Approved off-label indication:
    Severe refractory psoriasis
       
    Infliximab injection (hidradenitis suppurativa - off-label)

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    Formulary
    High Cost Medicine
    Red
    Approved off-label indication:
    Last line treatment for severe hidradenitis suppurativa
    Use in accordance with the local guideline at GSTFT. Requires individual funding application for exceptional cases, currently not recommended for routine commissioning

    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    
    Infliximab injection (psoriasis)

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    Formulary
    High Cost Medicine
    Red
    Approved for use in psoriasis 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 TA134: Infliximab for the treatment of adults with psoriasis
    Link  SE London APC position statement: Biosimilar infliximab    
    Ixekizumab injection

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

    Link  NICE TA442: Ixekizumab for treating moderate to severe plaque psoriasis    
    Cytotoxic Drug  Methotrexate tabs, subcutaneous injection (psoriasis)

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    Formulary
    Amber 3
    Psoriasis
       
    Mycophenolate mofetil tabs, caps (dermatology indications - off-label)

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    Formulary
    Amber 3
    Approved off-label indications:
  • Severe immunobullous disease
  • Severe atopic dermatitis
  • Severe psoriasis
    Reasons for prescribing should be clearly communicated to the patientís GP
    Restricted to use in patients patients unresponsive or intolerant of standard therapies. Use as a steroid-sparing immunosuppressant
  •    
    Pimecrolimus cream 1% (eczema)

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    Formulary
    Amber 2
    Use under specialist supervision only
    For moderate atopic eczema

    Link  NICE TA82: Pimecrolimus and tacrolimus for atopic dermatitis (eczema)    
    Pimecrolimus cream 1% (psoriasis - off-label)

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    Formulary
    Amber 2
    Approved off-label indication:
    Psoriasis of the face, flexures and genitals
    Use under specialist supervision only
       
    Rituximab injection (dermatology indications)

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    Formulary
    High Cost Medicine
    Red
    Approved off-label indication:
    Severe immunobullous disease
    Use in accordance with the local guideline at GSTFT

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

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

    Link  NICE TA350: Secukinumab for treating moderate to severe plaque psoriasis    
    Tacrolimus ointment 0.03%, 0.1% (eczema)

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    Formulary Use under specialist supervision only
    For moderate to severe atopic eczema

    Link  NICE TA82: Tacrolimus and pimecrolimus for atopic eczema    
    Thalidomide caps (dermatology indications - off-label)

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    Restricted Drug Restricted
    Red
    Approved for the following off-label dermatology indications (dermatology specialist use only):
  • Actinic prurigo (after failure of topical therapy, oral steroids and phototherapy)
  • Nodular prurigo (after failure of topical therapy, phototherapy and methotrexate)
  • Cutaneous Lupus Erythematosus (after failure of topical therapy, oral steroids, hydroxychloroquine and mepacrine)
    Follow internal guideline at GSTFT
  •    
    Ustekinumab injection (psoriasis)

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

    Link  NICE TA180: Ustekinumab for the treatment of adults with moderate to severe psoriasis    
    Ustekinumab injection (high dose)

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    Formulary
    High Cost Medicine
    Red
    Approved off-label use:
    High-dose treatment of severe chronic plaque psoriasis
       
     ....
    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
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    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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