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 Formulary Chapter 13: Skin - 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.

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13.05.03  Expand sub section  Drugs affecting the immune response
Dupilumab injection
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Formulary
Red
High Cost Medicine

Approved for treating moderate to severe atopic dermatitis as per NICE technology appraisal guidance (see link below)


 
Link  NICE TA534: Dupilumab for treating moderate to severe atopic dermatitis
   
Adalimumab injection (Hidradenitis suppurativa)
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Formulary
Red
High Cost Medicine
BlueTeq

Approved for hidradenitis suppurativa as per NICE technology appraisal guidance

 
Link  NICE TA392: Adalimumab for treating moderate to severe hidradenitis suppurativa
   
Adalimumab injection (psoriasis)
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Formulary
Red
High Cost Medicine

Approved as per detail in SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

In inadequate primary response, the following dose increase is also approved:

  • Dose increase from 40 mg every other week to 40 mg every week (category B* form required)

See SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

 
Link  NICE TA146: Adalimumab for the treatment of adults with psoriasis
   
Apremilast tabs
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Formulary
Red
High Cost Medicine
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 
       
    Brodalumab injection
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    Formulary
    Red
    High Cost Medicine

    Approved as per detail in SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

     
    Link  NICE TA511: Brodalumab for treating moderate to severe plaque psoriasis
       
    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
    Red
    High Cost Medicine
    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
    Red
    High Cost Medicine

    Approved as per detail in SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

    In inadequate primary response, the following dose increase is also approved:

    • Dose increase from 50 mg every week to 50 mg twice a week

    See SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

    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
       
    Guselkumab injection
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    Formulary
    Red
    High Cost Medicine

    Approved as per detail in SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

     
    Link  NICE TA521: Guselkumab for treating moderate to severe plaque 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
    Red
    High Cost Medicine

    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
    Red
    High Cost Medicine

    Approved as per detail in SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

    In inadequate primary response, the following off-label dose increase is also approved:

    • Dose increase from 5 mg/kg every 8 weeks to 5 mg/kg every 6 weeks (category B* form required)

    See SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

    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
    Red
    High Cost Medicine

    Approved as per detail in SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

     
    Link  NICE TA442: Ixekizumab for treating moderate to severe plaque psoriasis
       
    Cytotoxic Drug Methotrexate tabs, subcutaneous injection (eczema - off-label)
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    Formulary
    Red

    Approved off-label indication:

    Eczema (adults and paediatrics)

    Note: s/c methotrexate restricted to use in patients with adverse effects from oral methotrexate, or where there is poor compliance or concerns of potential impaired oral absorption.

     
       
    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 patient’s 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
    Red
    High Cost Medicine

    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
    Red
    High Cost Medicine

    Approved as per detail in SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

     
    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
    Red
    High Cost Medicine

    Approved as per detail in SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

    In inadequate primary response, the following off-label dose increases are also approved:

    • Dose increase from 45mg every 12 weeks to 90mg every 12 weeks in those <100kg
    • Dose increase from 90 mg every 12 weeks to to 90 mg every 8 weeks (category B* form required)
     
    Link  NICE TA180: Ustekinumab for the treatment of adults with moderate to severe psoriasis
       
     ....
    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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