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North Staffordshire Joint Formulary
North Staffordshire Clinical Commissioning Group
Stoke-on-Trent Clinical Commissioning Group
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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
Mycophenolate mofetil

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Formulary
Amber E

Mycophenolate mofetil 250mg capsules
Mycophenolate mofetil 500mg tablets
Mycophenolate mofetil 200mg per 1ml oral suspension

MHRA/CHM advice: Mycophenolate mofetil, mycophenolic acid: updated contraception advice for male patients (February 2018)

Link to ESCA (for rheumatology pts)

 
   
10.01.03  Expand sub section  Gold
Sodium aurothiomalate
(Myocrisin®)
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Amber

Myocrisin®Sodium aurothiomalate 20mg/1ml solution for injection ampoules
Myocrisin®Sodium aurothiomalate 100mg/1ml solution for injection ampoules 

 

DISCONTINUATION

Sanofi has confirmed the discontinuation of 10mg, 20mg and 50mg ampoules of Myocrisin from 30th June 2019 (being 3 months from the shortest expiry date). There are supplies within the supply chain, and will continue until current stock is depleted.

 

 
   
10.01.03  Expand sub section  Penicillamine
Penicillamine 
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Amber E

Penicillamine 125mg tablets
Penicillamine 250mg tablets

Amber E For autoimmune rheumatic diseases

Link to ESCA

 
   
10.01.03  Expand sub section  Antimalarials
Chloroquine (Avloclor®)
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Formulary
Amber

Avloclor® - Chloroquine phosphate 250mg tablets

 

 
   
Hydroxychloroquine sulfate

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Amber E

Hydroxychloroquine sulfate 200mg tablets

(Rheumatology)

Link to ESCA

 
   
10.01.03  Expand sub section  Drugs affecting the immune response to top
Cytotoxic Drug Azathioprine 
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Amber E

Azathioprine 25mg tablets
Azathioprine 50mg tablets

Link to ESCA

 
   
Ciclosporin (Prescribe by brand)
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Amber E

Ciclosporin 10mg capsules (only available as Neoral®)
Ciclosporin 25mg capsules
Ciclosporin 50mg capsules
Ciclosporin 100mg capsules

MHRA/CHM advice: ciclosporin must be prescribed and dispensed by brand name (December 2009)

Link to ESCA

 
   
Leflunomide 
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Amber E

Leflunomide 10mg tablets
Leflunomide 20mg tablets

Link to ESCA

 

 

 
   
Cytotoxic Drug Methotrexate 
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Amber E

Methotrexate 2.5mg tablets
Methotrexate injection (as pre-filled syringes/ pens/ injectors)- brands include Nordimet®, Zlatal®, Methofill® and Metoject PEN®

Prescribe WEEKLY (on the same day each week); orally as multiples of 2.5mg strength tablets.

Link to ESCA

MHRA/CHM advice: Methotrexate once-weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly dosing (September 2020)

 
   
10.01.03  Expand sub section  Cytokine modulators
Abatacept (Orencia®)
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Red
High Cost Medicine
NHS England
BlueTeq

Restriction: In line with NICE Guidance

Restriction: In accordance with NHS England prescribing policies

 
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: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
   
Adalimumab (Hyrimoz®, Amgevita®, Imraldi®, Hulio®, Humira®(Prescribe by brand)
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Red
High Cost Medicine
NHS England
BlueTeq

Restriction: In line with NICE Guidance

Restriction: In accordance with NHS England prescribing policies

Clinicians must ensure the biosimilar brand for their region is prescribed first-line.
(Hyrimoz is the first line biosimilar in West Midlands region; Amgevita is used in patients intolerant to citrate content i.e injection site reactions)

 
Link  UKMI: Adalimumab Biosimilar Comparison
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 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
   
Anakinra (Kineret®)
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Red
High Cost Medicine
NHS England

Restriction: In line with NICE Guidance

Restriction: In accordance with NHS England prescribing policies

Not routinely commissioned by NHS England for adult and paediatric indications except by prior IFR approval. Commissioned by NHS England for cryopyrin associated periodic syndrome -highly specialised criteria only.

 
Link  NICE NG100: Rheumatoid arthritis in adults: management
   
Apremilast (Otezla®)
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Red
High Cost Medicine
NHS England
BlueTeq

Restriction: In line with NICE Guidance

Restriction: In accordance with NHS England prescribing policies

 
Link  NICE TA433 : Apremilast for treating active psoriatic arthritis
   
Belimumab (Benlysta® )Black Triangle
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Red
High Cost Medicine
NHS England

Restriction: In line with NICE Guidance

Restriction: In accordance with NHS England prescribing policies

 

MHRA advice (May 2019):Belimumab (Benlysta▼)- increased risk of serious psychiatric events seen in clinical trials

 
Link  NICE TA397: Belimumab for treating active autoantibody-positive systemic lupus erythematosus
   
Certolizumab Pegol (Cimzia®)
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Red
High Cost Medicine
NHS England
BlueTeq

Restriction: In line with NICE Guidance

Restriction: In accordance with NHS England prescribing policies

 
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 DMARD
Link  NICE TA574: Certolizumab pegol for treating moderate to severe plaque psoriasis
   
Etanercept (Enbrel®, Benepali®, Erelzi®)
(Prescribe by brand)
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Red
High Cost Medicine
NHS England
BlueTeq

Restriction: In line with NICE Guidance

Restriction: In accordance with NHS England prescribing policies

 

 

 
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 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 (Simponi®)
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Red
High Cost Medicine
NHS England
BlueTeq

Restriction: In line with NICE Guidance

Restriction: In accordance with NHS England prescribing policies

 
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 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 (Flixabi®, Inflectra®, Remicade®, Remsima®)
(Prescribe by brand)
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Red
High Cost Medicine
NHS England
BlueTeq

Restriction: In line with NICE Guidance

Restriction: In accordance with NHS England prescribing policies

 

Not routinely commissioned by NHS England for Connective tissue disease, interstital lung disease, renal or sarcoidosis except by prior IFR approval.

 
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 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
   
Ixekizumab (Taltz® )Black Triangle
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Red
High Cost Medicine
BlueTeq

Restriction: In line with NICE Guidance

 
Link  NICE TA537: Ixekizumab for treating active psoriatic arthritis after inadequate response to DMARDs
   
Rituximab (MabThera®, Rixathon®, Truxima®)Black Triangle
(Prescribe by brand)
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Red
High Cost Medicine
NHS England
BlueTeq

Restriction: In line with NICE Guidance

Restriction: In accordance with NHS England prescribing policies

 

Not routinely commissioned by NHS England for connective tissue disease (interstitial lung disease), primary Sjorgren's disease or chronic inflammatory demyelinating polyneuropathy except by prior IFR approval.

 
Link  NICE TA195: Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
   
Secukinumab (Cosentyx®)Black Triangle
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Red
High Cost Medicine
NHS England
BlueTeq

Restriction: In line with NICE Guidance

Restriction: In accordance with NHS England prescribing policies

 

Not routinely commissioned by NHS England for paediatric indications except by prior IFR approval.

 
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 (RoActemra®)
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Red
High Cost Medicine
NHS England
BlueTeq

Restriction: In line with NICE Guidance 

Restriction: In accordance with NHS England prescribing policies

 

MHRA advice(July 2019): 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
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 TA518: Tocilizumab for treating giant cell arteritis
   
Sarilumab (Kevzara®)Black Triangle
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Red
High Cost Medicine
BlueTeq

Restriction: In line with NICE Guidance

 
Link  NICE TA485: Sarilumab for moderate to severe rheumatoid arthritis
   
Baricitinib (Olumiant®)Black Triangle
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Red
High Cost Medicine
BlueTeq

Restriction: In line with NICE Guidance

MHRA/CHM advice: Baricitinib (Olumiant®): risk of venous thromboembolism (March 2020)

MHRA/CHM advice: Baricitinib (Olumiant®): increased risk of diverticulitis, particularly in patients with risk factors (August 2020)

 
Link  MHRA drug safety update: Baricitinib (Olumiant): risk of venous thromboembolism
Link  NICE TA466: Baricitinib for moderate to severe rheumatoid arthritis
   
Tofacitinib  (Xeljanz®)Black Triangle
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Formulary
Red
High Cost Medicine
CCG
BlueTeq

Restriction: In line with NICE Guidance

 
Link  MHRA drug safety update: Tofacitinib (Xeljanz): new measures to minimise risk of venous thromboembolism and of serious and fatal infections
Link  NICE TA480: Tofacitinib for moderate to severe rheumatoid arthritis
Link  NICE TA543: Tofacitinib for treating active psoriatic arthritis after inadequate response to DMARDs
   
Upadacitinib (Rinvoq®)Black Triangle
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Red
High Cost Medicine
CCG
BlueTeq

Restriction: In line with NICE Guidance

MHRA/CHM advice: Baricitinib (Olumiant®): risk of venous thromboembolism (March 2020) (Upadacitinib)

 
Link  MHRA Drug Safety Update: Baricitinib (Olumiant▼)/ Upadacitinib risk of venous thromboembolism
Link  NICE TA665: Upadacitinib for treating severe rheumatoid arthritis
   
10.01.03  Expand sub section  Sulfasalazine
Sulfasalazine (Salazopyrin EN-Tabs)
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Formulary
Amber E

Sulfasalazine gastro resistant 500mg tablets

Please note only the gastro resistant tablets are licensed for treatment of active rheumatoid arthritis.

Link to ESCA

 

 
   
 ....
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 children's 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
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Red

Medicines that can only be prescribed within Secondary Care. Examples of medicines which fall into this category are: Certain new medicines and new indications for older medicines where there is at present no experience of use in Primary Care. Medicines or dressings not available or prescribable in Primary Care. Where a medicine has been classified as Amber E, but an approved shared-care guideline is not yet available   

Amber

Medicines which can be prescribed within Secondary Care, but are only suitable for prescribing in Primary Care after specialist referral. There is no need for approved shared care guidelines for medicines in this category. This replaces Amber 2 on the North Staffs Formulary.   

Amber E

Medicines which can be prescribed within Secondary Care, but are only considered suitable for prescribing in Primary Care under an approved shared-care agreement (ESCA) or Rationale for Initiation, Continuation and Discontinuation (RICaD). This replaces Amber 1 on the North Staffs Formulary  

Green

Medicines which can be prescribed in either Primary or Secondary Care.  

Grey

These medicines have been reviewed by the New Medicines Committee and the Area Prescribing Committee and found not to be suitable for inclusion in the Joint Formulary. Inadequate or weak evidence for efficacy No clearly defined local need Lack of long term safety data No perceived benefit over established formulary alternatives Prescribers can consider these medicines where formulary alternatives are unsuitable, ineffective or not tolerated.  

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