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 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
10.01  Drugs used in rheumatic diseases and gout
10.01  Rheumatoid arthritis and other inflammatory disorders
10.01  Osteoarthritis and soft-tissue disorders
10.01.01  Non-steroidal anti-inflammatory drugs
 note 
Note: diclofenac use is restricted, it can be used short term use for post-operative pain
Long term use
  • Ibuprofen low dose - First line treatment
  • Naproxen low dose - Second line treatment
  • Naproxen high dose- Third line treatment
  • Diclofenac - Fourth line treatment
 
Ibuprofen
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Formulary
Green

Tablets: 200mg, 400mg, 600mg
Suspension (sugar-free available): 100mg/5mL 

 
Link  MHRA Drug Safety Update (June 2015): High-dose ibuprofen (≥2400mg/day): small increase in cardiovascular risk
 
Naproxen tablets
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Green

Tablets: 250mg, 500mg 

Note: a naproxen 125mg in 5ml suspension (unlicensedunlicensed) is also approved. 

 
 
Diclofenac
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Green plus

Tablets: 25mg, 50mg

The use of oral diclofenac is restricted. It can be used short-term for post operative pain, or as a fourth line choice for long-term use.

  • Topical formulations are NOT on the formulary
 
Link  MHRA Drug Safety Update (Dec 2007): NSAIDs and coxibs: balancing of cardiovascular and gastrointestinal risks
Link  MHRA Drug Safety Update (Jan 2015): Cox-2 selective inhibitors and non-steroidal anti-inflammatory drugs (NSAIDs): Cardiovascular safety.
Link  MHRA Drug Safety Update (June 2013): Diclofenac: new contraindications and warnings
Link  MHRA Drug safety Update (Oct 2012): Non-steroidal anti- inflammatory drugs (NSAIDs): cardiovascular risks
 
Diclofenac Sodium
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Red

Injection: 75 mg/3 ml

 
Link  MHRA Drug Safety Update (June 2013): Diclofenac: new contraindications and warnings
 
Diclofenac Suppositories
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Red

Diclofenac: new contraindications and warnings - GOV.UK (www.gov.uk)

 
 
Flurbiprofen
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Red
 
 
Celecoxib
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Alternatives
Green
  • Capsules: 100mg, 200mg
 
 
Etodolac
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Alternatives
Green plus
  • Capsules: 300mg
  • MR tablets: 600mg
 
 
Etoricoxib
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Alternatives
Green plus
  • Tablets: 30mg, 60mg, 90mg, 120mg
 
 
Indometacin
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Alternatives
Green
  • Capsules: 25 mg, 50 mg
  • SR Capsules: 75 mg
  • Suppositories: 100 mg
 
 
Mefenamic Acid
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Alternatives
Green plus
  • Capsules: 250 mg
  • Tablets: 500 mg
  • Suspension: 50 mg/5 mL
 
 
Nabumetone
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Alternatives
Green plus
  • 500mg tablets
 
 
Phenylbutazone
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Alternatives
Red

Tablets: 100mg

Indication: Ankylosing Spondylitis. 

Used only by a specialist in severe cases where other treatments have been found unsuitable.

 
 
10.01.01  Aspirin to top
10.01.02  Corticosteroids
10.01.02.01  Systemic corticosteroids
10.01.02.02  Local corticosteroids injections
Dexamethasone Phosphate
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Red

Injection: 3.3 mg/1 mL, 4 mg/1 mL, 6.6 mg/2 mL, 8 mg/2 mL 

 
 
Hydrocortisone acetate 25mg in 1ml injection
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Formulary
Green
 
 
Methylprednisolone Acetate 40mg in 1ml injection
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Formulary
Green
 
 
Methylprednisolone Acetate 40mg with lidocaine 1% injection
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Green
 
 
Triamcinolone Acetonide
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Green
  • The following triamcinolone acetonide preparations are approved:
    • Kenalog® - 40mg in 1ml and intramuscular/intra-articular injection.
    • Adcortyl® - 50mg in 5ml intradermal/intra-articular injection. 
 
 
Triamcinolone hexacetonide 20mg in 1ml
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Unlicensed Drug Unlicensed
Red
  • Only approved for paediatric use. 
 
 
10.01.03  Drugs which suppress the rheumatic disease process
BaricitinibBlack Triangle (Olumiant®)
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Red
High Cost Medicine
CCG
  • Approved for the treatment of moderate to severe rheumatoid arthritis in adults in line with NICE.
  • Approved for use in monogenic interferonopathis in adults and children 2 years and over in line with NHS England Clinical Commissioning Policy.

 

 
Link  Clinical Commissioning Policy Baricitinib for use in monogenic interferonopathies (adults and children 2 years and over) (210506P)
Link  Clinical Commissioning Policy: Baricitinib for patients hospitalised due to COVID-19 (adults and children aged 2 years and over)
Link  MHRA Drug Safety Update (April 2023): Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality
Link  MHRA Drug Safety Update (Aug 2020): Baricitinib (Olumiant▼): increased risk of diverticulitis, particularly in patients with risk factors
Link  MHRA Drug Safety Update (Mar 2020): Baricitinib (Olumiant▼): risk of venous thromboembolism
Link  NICE TA466: Baricitinib for moderate to severe rheumatoid arthritis
Link  NICE TA681: Baricitinib for treating moderate to severe atopic dermatitis
 
Filgotinib (Jyseleca®)
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Red
High Cost Medicine
CCG
  • Approved for treating moderate to severe rheumatoid arthritis in line with NICE

 

 
Link  MHRA Drug Safety Update (April 2023): Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality
Link  NICE TA676: Filgotinib for treating moderate to severe rheumatoid arthritis
Link  NICE TA792: Filgotinib for treating moderately to severely active ulcerative colitis
 
Tofacitinib (Xeljanz®)
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Red
High Cost Medicine
CCG
  • 5mg and 10mg tablets.
  • Approved for treating junveline idiopathic arthritis in line with NICE
  • Approved for the treatment of active psoriatic arthritis after inadequate response to DMARDs in line with NICE.
  • Approved for the treatment of moderate to severe rheumatoid arthritis in adults in line with NICE.
  • Approved for for treating active ankylosing spondylitis in line with NICE
 
Link  MHRA Drug Safety Update (April 2023): Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality
Link  MHRA Drug Safety Update (Mar 2020): Tofacitinib (Xeljanz▼): new measures to minimise risk of venous thromboembolism and of serious and fatal infections
Link  MHRA Drug Safety Update (May 2019): Tofacitinib (Xeljanz▼): restriction of 10 mg twice-daily dose in patients at high risk of pulmonary embolism while safety review is ongoing
Link  NICE TA480: Tofacitinib for moderate to severe rheumatoid arthritis Technology appraisal guidance
Link  NICE TA543: Tofacitinib for treating active psoriatic arthritis after inadequate response to DMARDs
Link  NICE TA547: Tofacitinib for moderately to severely active ulcerative colitis
Link  NICE TA735: Tofacitinib for treating juvenile idiopathic arthritis
Link  NICE TA920: Tofacitinib for treating active ankylosing spondylitis
 
Minocycline
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Green plus
  • Only approved for use in patients with rheumatoid arthritis who are unable to tolerate biologics and other DMARDs.
 
 
10.01.03  Gold to top
10.01.03  Penicillamine
Penicillamine
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Formulary
Amber
 
 
10.01.03  Antimalarials
Hydroxychloroquine
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Formulary
Amber

 

 

 
Link  County Durham and Darlington Shared Care Guideline: Hydroxychloroquine
Link  MHRA Drug Safety Update (Feb 2022): Hydroxychloroquine, chloroquine: increased risk of cardiovascular events when used with macrolide antibiotics; reminder of psychiatric reactions
Link  North of Tyne, Gateshead and North Cumbria - Hydroxychloroquine Shared Care Guidance v5 (October 2022)
Link  South Tyneside & Sunderland APC Shared Care Guideline - Hydroxychloroquine in Rheumatology
 
10.01.03  Drugs affecting the immune response
Cytotoxic Drug Azathioprine
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Amber
  • See section 8.2.1
 
Link  County Durham and Darlington Shared Care Guideline: Azathioprine
Link  South Tyneside & Sunderland APC Shared Care Guideline - Azathioprine in Rheumatology
Link  Tees Valley Shared Care Guideline: Azathioprine
 
Ciclosporin
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Amber
  • See section 8.2.2
 
Link  County Durham and Darlington Shared Care Guideline: Ciclosporin
Link  Tees Valley Shared Care Guideline: Ciclosporin
 
Leflunomide
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Formulary
Amber
 
Link  County Durham and Darlington Shared Care Guideline: Leflunomide
Link  South Tyneside & Sunderland APC Shared Care Guideline - Leflunomide in Rheumatology
Link  Tees Valley Shared Care Guideline: Leflunomide
 
Cytotoxic Drug Methotrexate
(Rheumatology)
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Formulary
Amber
 
Link  County Durham and Darlington Shared Care Guideline: Methotrexate
Link  South Tyneside & Sunderland APC Shared Care Guideline - Methotrexate in Rheumatology
Link  Tees Valley Shared Care Guideline: Methotrexate
 
Mycophenolate
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Amber
 
Link  County Durham and Darlington Shared Care Guideline: Mycophenolate mofetil and mycophenolic acid
Link  South Tyneside & Sunderland APC Shared Care Guideline - Mycophenolate in Rheumatology
Link  Tees Valley Shared Care Guideline: Mycophenolate mofetil
 
10.01.03  Cytokine modulators
Abatacept (Orencia®)
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  • Abatacept 250mg injection is approved for:
    • Juvenile idiopathic arthritis in patients aged six years and above (licensed) and under six years. It should only be prescribed with informed consent.
    • People aged 6 years and older to treat polyarticular juvenile idiopathic arthritis (JIA) whose diease has responded inadequately to other DMARDs, including at least one tumour necrosis factor (TNF) inhibitor in accordance with NICE.
    • Rheumatoid arthritis after the failure of a TNF inhibitor in line with NICE.
    • Treatment in adults with severe rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed in accordance with NICE.
    • Treatment of severe treatment-resistant morphoea in line with NHS England Clinical Commissioning Policy
    • Treating modertae rheumatoid arthritis after conventional DMARDs have failed in line with NICE
    • Treating idiopathic inflammatory myopathies in adults and children aged 2 and over in line with NHS England Commissioning Policy
  • Abatacept 125mg SC injection (prefilled syringe) is approved for moderate to severe rheumatoid arthritis in accordance with NICE.
 
Link  Clinical Commissioning Policy (210505P) Statement: Abatacept for treatment of severe treatment-resistant morphoea (localised scleroderma)
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
Link  NICE TA715: Adalimumab, etanercept, infliximab and abatacept for treating moderate rheumatoid arthritis after conventional DMARDs have failed
 
Adalimumab
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  • Adalimumab is approved for:
    • The treatment of adults with severe rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed in accordance with NICE 
    • Rheumatoid arthritis after the failure of a TNF inhibitor in accordance with NICE.
    • Treatment of severe active ankylosing spondylitis in adults whose disease has responded inadequately to, or who cannot tolerate, non-steroidal anti-inflammatory drugs in accordance with NICE.
    • Psoriatic arthritis in accordance with NICE.
    • As a second-line anti-TNF therapy in children with juvenile idiopathic arthritis and uveitis.
    • Children and adults aged 2 years and older to treat polyarticular juvenile idiopathic arthritis (JIA) whose disease has responded inadequately to 1 or more DMARD in accordance with NICE.
    • Treating moderate rheumatoid arhritis after conventional DMARDs have failed in line with NICE

 

 
Link  NICE TA195: Rheumatoid arthritis - after failure of a TNF inhibitor
Link  NICE TA199: Psoriatic arthritis
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
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
Link  NICE TA715: Adalimumab, etanercept, infliximab and abatacept for treating moderate rheumatoid arthritis after conventional DMARDs have failed
 
Anakinra (Kineret®)
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Red
  • Approved for:
    • Juvenile Idiopathic Arthritis (JIA) in line with NICE and NHS England Clinical Commissioning Policy: E03/P/d
    • Periodic Fevers and Autoinflammatory conditions in line with NHS England Clinical Commissioning Policy: 170062P
    • Adult‑onset Still’s disease and systemic juvenile idiopathic arthritis in people 8 months and older in line with NICE
    • Cryopyrin Associated Periodic Syndrome in line with NHSE Service Specification
    • The treatment of severe gout in patients who have not responded to other treatment and for patients with pseudogout who have failed to respond to conventional treatment or unable to tolerate conventional treatment.
    • Chronic Infantile Neurocutaneous Arthritis (CINCA) and Muckle-Wells Syndrome (unlicensedunlicensed indications).
    • Islet cell transplantation as part of a protocol including alemtuzumab and etanercept to improve outcomes (i.e. insulin dependance)
    • Haemophagocytic Lymphohistiocytosis (HLH) for adults and children in all ages

 

 
Link  NICE TA685: Anakinra for treating Still’s disease
 
Apremilast (Otezla®)
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Red
High Cost Medicine
  • Approved for the treatment of psoriatic arthritis in line with NICE
 
Link  MHRA Drug Safety Update (Jan 2017): Apremilast (Otezla ▼): risk of suicidal thoughts and behaviour
Link  NICE TA433: Apremilast for treating active psoriatic arthritis
 
Belimumab (Benlysta®)
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Red

  • Approved for treating active autoantibody-positive systemic lupus erythematosus in line with NICE

 
Link  MHRA Drug Safety Update (April 2019): Belimumab (Benlysta▼): increased risk of serious psychiatric events seen in clinical trials
Link  NICE TA752: Belimumab for treating active autoantibody-positive systemic lupus erythematosus
 
Bimekizumab  (Bimzelx®)
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Red
High Cost Medicine
CCG
  • 160mg/1ml solution for injection - pre-filled pen and syringes
  • Approved for the treatment of active psoriatic arthritis in line with NICE
  • Approved fofr the treatment of axial spondyloartritis in line with NICE



 
Link  NICE TA916: Bimekizumab for treating active psoriatic arthritis
Link  NICE TA918: Bimekizumab for treating axial spondyloarthritis
 
Certolizumab Pegol (Cimzia®)
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Red
  • Approved for:
    • Adults with severe rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed in accordance with NICE.
    • Rheumatoid arthritis after inadequate response to a TNF-alpha inhibitor in accordance with NICE.
    • Severe active ankylosing spondylitis in adults whose disease has responded inadequately to, or who cannot tolerate, non-steroidal anti-inflammatory drugs in accordance with NICE.
    • Psoriatic arthritis in accordance with NICE.

 
Link  NICE TA 415 - Certolizumab pegol for treating rheumatoid arthritis after inadequate response to a TNF-alpha inhibitor
Link  NICE TA375: 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 TA445: Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs
Link  NICE TA574: Certolizumab pegol for treating moderate to severe plaque psoriasis
 
Etanercept
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Red
High Cost Medicine

Prescribe by brand name.

  • Approved formulations include 10mg (Enbrel®) 25mg injection (Enbrel®, Benepali® & Erelzi®), 50mg injection (Enbrel®, Benepali® & Erelzi®). 
  • Approved for:
    • Treatment in adults with severe rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed in line with NICE.
    • Rheumatoid arthritis after the failure of a TNF inhibitor in line with NICE.
    • Psoriatic arthritis in accordance with NICE.
    • Treatment of severe active ankylosing spondylitis in adults whose disease has responded inadequately to, or who cannot tolerate, non-steroidal anti-inflammatory drugs in accordance with NICE.
    • The treatment of juvenile idiopathic arthritis (JIA) in people 2 years or older whose disease has responded inadequately to, or who are intolerant of methotrexate in line with NICE.
    • Treatment of Juvenile Scleroderma (Its use will be subject to informed consent and specialists using etanercept in this indication should collect data on patient outcomes. If after a six month trial, treatment were found to be beneficial, it would be continued for two years. If unsuccessful after six months, treatment should be discontinued).
    • People aged 2 years and older to treat polyarticular juvenile idiopathic arthritis (JIA) whose diease has responded inadequately to, or who are intolerant of methotrexate in line with NICE.
    • Treating moderate rheumatoid arthritis after conventional DMARDs have failed in line with NICE


 
Link  NICE TA35: Adult psoriasis
Link  NICE TA195: Rheumatoid arthritis after the failure of a TNF inhibitor
Link  NICE TA199: Psoriatic arthritis
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for JIA
Link  NICE TA375: 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 TA715: Adalimumab, etanercept, infliximab and abatacept for treating moderate rheumatoid arthritis after conventional DMARDs have failed
 
Golimumab (Simponi®)
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Red
High Cost Medicine
CCG
  • Approved for:
    • Rheumatoid arthritis in accordance with NICE.
    • Psoriatic arthritis in accordance with NICE.
    • The treatment of severe active ankylosing spondylitis in adults whose disease has responded inadequately to, or who cannot tolerate, non-steroidal anti-inflammatory drugs in accordance with NICE.
    • Treatment in adults with severe rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed in accordance with NICE.
    • The treatment of non-radiographic axial spondyloarthritis in accordance with NICE

 

 
Link  NICE TA220: psoriatic arthritis
Link  NICE TA497: Golimumab for treating non-radiographic axial spondyloarthritis
Link  NICE TA375: 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
 
Guselkumab  (Tremfya)
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  • 100 mg/1 mL as a pre-filled syringe
  • Approved (alone or with methotrexate) for treating active psoriatic arthritis after inadequate response to DMARDs in line with NICE

Overview | Guselkumab for treating active psoriatic arthritis after inadequate response to DMARDs | Guidance | NICE

 
Link  NICE TA815: Guselkumab for treating active psoriatic arthritis after inadequate response to DMARDs
 
Infliximab (Remsima®, Inflectra®, Remicade® )
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Red
  • Approved for:
    • Treatment in adults with severe rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs have failed in accordance with NICE.
    • Rheumatoid arthritis after the failure of a TNF inhibitor in line with NICE.
    • Psoriatic arthritis in accordance with NICE.
    • JIA in patients who have not responded to etanercept.
    • Juvenile dermatomyositis and paediatric onset Behcet’s disease where there has been intolerance or lack of response to 1st and 2nd line therapies.
    • The treatment of severe active ankylosing spondylitis in adults whose disease has responded inadequately to, or who cannot tolerate, non-steroidal anti-inflammatory drugs in accordance with NICE.
    • Treating moderate rheumatoid arthritis after conventional DMARDs have failed in line with NICE


  • Prescribe by brand name; Remsima®, Inflectra®, Remicade®. 

 

 
Link  Infliximab subcutaneous injection (Remsima SC ®) - interim COVID-19 guidance
Link  NICE TA195: Rheumatoid arthritis (after failure of a TNF inhibitor)
Link  NICE TA199: Psoriatic arthritis
Link  NICE TA375: 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 TA715: Adalimumab, etanercept, infliximab and abatacept for treating moderate rheumatoid arthritis after conventional DMARDs have failed
 
Ixekizumab (Taltz®)
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Red
High Cost Medicine
CCG
  • 80mg/ml pre-filled syringe or pen
  • Approved for the treatment of axial spondyloarthritis in line with NICE
  • Approved for the treatment of active psoriatic arthritis after inadequate response to DMARDS

 
Link  NICE TA537: Ixekizumab for treating active psoriatic arthritis after inadequate response to DMARDs
Link  NICE TA718: Ixekizumab for treating axial spondyloarthritis
 
Rituximab
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Red
  • Approved for:
    • Adults with severe systemic lupus erythematosus who have failed conventional therapies.
    • Rheumatoid arthritis after the failure of a TNF inhibitor in line with NICE.
    • Combination with methotrexate as first-line biological therapy in cases where there is an absolute contraindication to tumour necrosis factor inhibitors (NETAG approval).
    • Combination with other (non-methotrexate) disease modifying antirheumatic drugs and as monotherapy in cases in which conventional treatment with tumour necrosis factor inhibitors or methotrexate is deemed unsafe (NETAG approval).
    • For immunoglobulin G4-related disease (IgG4-RD) in accordance with NHS England Commissioning Criteria
    • Myositis in accordance with NHS England Commissioning Criteria
    • Juvenile Idiopathic Arthritis (JIA) in accordance with NHS England Commissioning Criteria

 

 
Link  NHS England Commissioning Policies (Specialised Rheumatology)
Link  NICE TA195: Rheumatoid arthritis - after failure of a TNF inhibitor
Link  NTAG - Treatment Appraisal Decision Summary - Rituximab Biosimilars
Link  MHRA Drug Safety Update (Dec 2013): Rituximab: screen for hepatitis B virus before treatment.
Link  MHRA Drug Safety Update (Dec 2014): Rituximab: progressive multifocal leukoencephalopathy in a patient
 
Sarilumab  (Kevzara®)
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Red
High Cost Medicine

  • 150mg/1.14mL & 200mg/1.14mL injection

  • Approved as an option for treating active rheumatoid arthritis in adults whose disease has responded inadequately to intensive therapy with a combination of conventional disease-modifying antirheumatic drugs (DMARDs) in line with NICE

 
Link  NICE TA485: Sarilumab for moderate to severe rheumatoid arthritis
 
Secukinumab (Cosentyx®)
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Red
  • Approved for active ankylosing spondylitis in line with NICE.
  • Approved for psoriatic arthritis in line with NICE.
  • Approved for the treatment of non-radiographic axial spondyloarthritis in line with NICE
 
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
Link  NICE TA719: Secukinumab for treating non-radiographic axial spondyloarthritis
 
Tocilizumab (RoActemra®)
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Red
NHS England
CCG
BlueTeq
  • IV preparations approved for:
    • Systemic JIA in children and young people aged 2 years and older in line with NICE.
    • People aged 2 years and older to treat polyarticular juvenile idiopathic arthritis (JIA) whose diease has responded inadequately to previous therapy with methotrexate in line with NICE.
    • An alternative treatment to anakinra for patients with systemic onset JIA who have already received treatment with etanercept and adalimumab (NETAG approval). Not recommended for polyarticular JIA.
    • Rheumatoid arthritis in accordance with NICE.
    • Treatment in adults with severe rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed in accordance with NICE.
  • 162mg SC injection is approved for:
    • Rheumatoid arthritis in accordance with NICE.
    • Giant cell arteritis in adults only if:
      • they have relapsing or refractory disease
      • they have not already had tocilizumab
      • tocilizumab is stopped after 1 year of uninterrupted treatment at most.
  • Monitoring: monitoring of tocilizumab in adult patients can be undertaken by GPs under a shared care arrangement Amber

 

 
Link  MHRA Drug Safety Update (July 2019): Tocilizumab (RoActemra): rare risk of serious liver injury including cases requiring transplantation
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: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA518: Tocilizumab for treating giant cell arteritis
Link  North of Tyne, Gateshead and North Cumbria - Tocilizumab monitoring Shared Care Guideline 2023
 
Upadacitinib (Rinvoq®)
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Red
High Cost Medicine
CCG
  • Approved for the treatment of severe active rheumatoid arthritis in adults in line with NICE.
  • Approved for the treatment of moderate rheumatoid arthritis in line with NICE.
  • Approved for the treatment of active psoriatic arthritis after inadeqaute response to DMARDs in line with NICE.



 
Link  MHRA Drug Safety Update (April 2023): Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality
Link  NICE TA665: Upadacitinib for treating severe rheumatoid arthritis
Link  NICE TA744: Upadacitinib for treating moderate rheumatoid arthritis
Link  NICE TA768: Upadacitinib for treating active psoriatic arthritis after inadequate response to DMARDs
Link  NICE TA814: Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis
Link  NICE TA829: Upadacitinib for treating active ankylosing spondylitis
Link  NICE TA861: Upadacitinib for treating active non-radiographic axial spondyloarthritis
 
Ustekinumab (Stelara®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Approved for psoriatic arthritis in accordance with NICE.
 
Link  MHRA Drug Safety Update (Jan 2015): Ustekinumab (Stelara): risk of exfoliative dermatitis
Link  NICE TA340: Ustekinumab for treating active psoriatic arthritis (Updated March 2017)
 
10.01.03  Sulfasalazine to top
Sulfasalazine E/C tablets
View adult BNF View SPC online View childrens BNF
Formulary
Amber
 
Link  County Durham and Darlington Shared Care Guideline: Sulfasalazine
Link  Newcastle, North Tyneside and Northumberland Guidelines (incorporated by Gateshead) for the Monitoring of Immune Modifying Drugs (IMDs) in Stable Adult Patients (excluding post transplantation) in Primary and Secondary Care
Link  South Tyneside & Sunderland APC Shared Care Guideline - Sulfasalazine in Rheumatology
Link  Tees Valley Shared Care Guideline: Sulfasalazine
 
10.01.04  Gout and cytotoxic-induced hyperuricaemia
10.01.04  Acute attacks of gout
Colchicine
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Formulary
Green
 
 
10.01.04  Long-term control of gout
Allopurinol
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First Choice
Green
  • An allopurinol 100mg in 5ml suspension (unlicensedunlicensed) is also approved for use. 
 
Benzbromarone
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Formulary
Red

Tablets: 100mg

Special order product

 
 
Febuxostat (Adenuric® )
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Formulary
Green
  • Approved for patients where allopurinol is not tolerated or contraindicated in line with NICE.
 
Link  NICE NG219: Gout: diagnosis and management
 
Probenecid
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Unlicensed Drug Unlicensed
Green plus

Tablets: 500mg

 
 
10.01.04  Hyperuricaemia associated with cytotoxic drugs
Allopurinol
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Formulary
Green
  • An allopurinol 100mg in 5ml suspension (unlicensedunlicensed) is also approved for use. 
 
 
Rasburicase
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Formulary
Red
  • Only approved for prophylactic use in high risk patients.
 
 
Sulfinpyrazole
View adult BNF View SPC online View childrens BNF
Formulary
Red

Tablets: 100mg, 200mg

 
 
10.01.05  Other drugs for rheumatic diseases to top
Autologous chondrocyte implantation
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Formulary
Red

Commissioning: NHS England 

Overview | Autologous chondrocyte implantation using chondrosphere for treating symptomatic articular cartilage defects of the knee | Guidance | NICE

 
 
Avacopan (Tavneos®)
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Formulary
Red
  • an option for treating severe active granulomatosis with polyangiitis or microscopic polyangiitis in adults - in line with NICE TA825
 
 
10.02  Drugs used in neuromuscular disorders
Mexiletine (Namuscla®)
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Formulary
Red
High Cost Medicine
BlueTeq

  • Approved for the treatment of myotonia in patients with non-dystrophic myotonic disorders in line with NICE and NHSE commissioning policy (SSC2001). 


 

 
Link  NICE TA748: Mexiletine for treating the symptoms of myotonia in non-dystrophic myotonic disorders
 
Nusinersen (Spinraza®)
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Formulary
Red
High Cost Medicine
  • 12mg solution for injection
  • Approved as an option for treating 5q spinal muscular atrophy (SMA) types 1, 2 or 3 in line with NICE.

 

 
Link  NHS England Urgent Clinical Commissioning Policy Statement (170018/P)
Link  NICE TA588: Nusinersen for treating spinal muscular atrophy
 
RisdiplamBlack Triangle (Evrysdi®)
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Formulary
Red
  • 0.75mg/1ml oral solution
  • Approved for treating spinal muscular atrophy in line with NICE
  • To be provided by Newcastle Hospitals homecare service only 
 
Link  NICE TA755: Risdiplam for treating spinal muscular atrophy
 
10.02.01  Drugs which enhance neuromuscular transmission
Ataluren (Translarna®)
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Formulary
Red
  • Approved as an option for treating Duchenne muscular dystrophy resulting from a nonsense mutation in the dystrophin gene in people 2 years and over who can walk - in line with NICE HST22.
 
Link  NICE HST22: Ataluren for treating Duchenne muscular dystrophy with a nonsense mutation in the dystrophin gene
 
10.02.01  Anticholinesterases
Edrophonium Chloride
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Formulary
Red
 
 
Neostigmine
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Formulary
Green plus
  • 2.5mg in 1ml injection
 
 
Pyridostigmine Bromide
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
10.02.01  Immunosuppressant therapy
10.02.01  Acetylcholine-release enhancers to top
10.02.02  Skeletal muscle relaxants
Baclofen
(Tablets, SF liquid & injection)
View adult BNF View SPC online View childrens BNF
First Choice
Green
  • The following baclofen intrachecal injections (unlicensedunlicensed) are also approved; 36mg in 12ml, and 72mg in 12ml intrathecal injections.Red Traffic Light
 
Diazepam
(Tablets, solution, syrup, injection)
View adult BNF View SPC online View childrens BNF
First Choice
Green
  • Note: diazepam 10mg tablets are no longer on the formulary. 
 
Controlled Drug Cannabis extract (Sativex®)
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Formulary
Amber
  • cannabidiol 2.5mg/dronabinol 2.7mg per dose oromucosal spray
  • approved to treat moderate to severe spasticity in adults with multiple sclerosis in line with NICE Amber
 
Link  NENC Shared Care Protocol: Sativex (delta-9-tetrahydrocannabinol / cannabidiol) Oromucosal Spray
Link  NICE NG144: Cannabis-based medicinal products
 
Dantrolene
(Capsules)
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Alternatives
Green
 
 
Tizanidine
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus
  • Approved for use on advice from neurologists when other treatments are unsuitable.
 
 
10.02.02  Other muscle relaxants
10.02.02  Nocturnal leg cramps
Quinine sulfate
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • 300mg tablets
  • Approved for nocturnal leg cramps in accordance with MHRA advice
 
 
10.03  Drugs for the treatment of soft-tissue disorders and topical pain relief
10.03  Extravasation to top
10.03.01  Enzymes
Hyaluronidase (Hyalase®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
10.03.02  Rubefacients, topical NSAIDs, capsaicin, and poultices
10.03.02  Topical NSAIDs and counter-irritants
Ibuprofen gel
(5%)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
10.03.02  Capsaicin
Capsaicin
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • 0.025% cream
    • approved for use as an adjunct to core treatment for knee and hand osteoarthritis as per NICE


 
Link  NICE NG226 - Osteoarthritis in over 16s: diagnosis and management
 
10.03.02  Poultices to top
 ....
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
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing.  

Amber

Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.  

Green plus

Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs.  

Green

Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care.  

Black

NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria.   

Brown

UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.  

Not Recomended

NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status.  

netFormulary