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Sunderland Joint Formulary
NHS Sunderland Clinical Commissioning Group
South Tyneside and Sunderland NHS Foundation Trust
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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
Cytotoxic Drug Methotrexate
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First Choice
Amber
Tablets: 2.5 mg
Prefilled pen (Metoject): 7.5mg, 10mg, 12.5mg, 15mg, 17.5mg, 20mg, 22.5mg, 25mg, 27.5mg, 30mg

Note: ONLY 2.5mg strength tablets to be prescribed. No other strengths to be prescribed 
Sulfasalazine
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First Choice
Amber
EC Tablets: 500 mg
Oral suspension (sugar-free): 250 mg/5 mL
 
Hydroxychloroquine sulfate
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First Choice
Amber
Tablets: 200 mg 
Leflunomide
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Second Choice
Amber
Tablets: 10 mg, 20 mg 
   
Filgotinib (Jyseleca)
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Formulary
Red

Tablets: 100mg and 200mg

 
Link  NICE TA 676: Filgotinib for treating moderate to severe rheumatoid arthritis
   
Cytotoxic Drug Azathioprine
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Alternatives
Amber
Tablets: 25 mg, 50 mg 
Link  NICE TA 480: Tofacitinib for moderate to severe rheumatoid arthritis
   
Ciclosporin (Neorall)
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Alternatives
Amber

Capsules: 10 mg, 50 mg, 100 mg
Oral solution (sugar-free): 100 mg/1 mL

 
   
Penicillamine
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Alternatives
Amber

Tablets: 125 mg, 250 mg

Note: this is as an alternative after biologics

*FOR NEUROLOGY INDICATIONS (SUCH AS WILSON'S), PENICILLAMINE SHOULD BE CONSIDERED A RED DRUG*

 
   
Sodium Aurothiomalate
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Alternatives
Amber

Injection: 10 mg/0.5 mL, 50 mg/0.5 mL

Note: this is as an alternative after biologics

 
   
Tofacitinib
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Alternatives
Red

Tablets: 5mg

 
Link  NICE TA 480: Tofacitinib for moderate to severe rheumatoid arthritis
Link  NICE TA 543: Tofacitinib for treating active psoriatic arthritis after inadequate response to DMARDs
Link  NICE TA 547: Tofacitinib for moderately to severely active ulcerative colitis
   
Sarilumab
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Alternatives
Red

Pre-filled pen: 150mg, 200mg
Syringe: 150mg, 200mg

 
Link  NICE TA 485: Sarilumab for moderate to severe rheumatoid arthritis
   
Baricitinib (Olumiant)
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Alternatives
Red

Film coated tablets: 2mg, 4mg

 
Link  NICE TA 466: Baricitinib for moderate to severe rheumatoid arthritis
Link  NICE TA 681: Baricitinib for treating moderate to severe atopic dermatitis
   
Mycophenolate
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Unlicensed Drug Unlicensed
Amber
Capsules: 250mg
Tablets: 500mg 
   
10.01.03  Expand sub section  Cytokine modulators
 note 

After failure with 2 DMARDS, including Methotrexate (if not tolerated) over a 6-month period and DAS > 5.1

Adalimumab (Amgevita(biosimilar) or Humira)
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First Choice
Red
High Cost Medicine

Amgevita is the biosimilar which is recommended for use first line

 

Pre-filled syringe or pen: 40 mg
Injection (vial): 40 mg/0.8 mL

Note: Subcutaneous first choice with MTX

 
Infliximab
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Second Choice
Red
High Cost Medicine
Solution for infusion: 100mg

Note: Intravenous 2nd line with MTX 
Link  NICE TA134: Infliximab for the treatment of adults with psoriasis
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
   
Certolizumab Pegol
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Second Choice
Red
High Cost Medicine

Pre-filled syringe: 200 mg


Note: Option if anti-TNF withdrawn during 1st 6 months due to adverse effects

Also approved for:
-Adults with severe active Ankylosing Spondylitis who have had an inadequate response to, or are intolerant to NSAIDs
-In combination with MTX, is indicated for the treatment of active psoriatic arthritis in adults when the response to previous DMARD therapy has been inadequate

 
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
   
Golimumab
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Second Choice
Red
High Cost Medicine
Injection (pre-filled pen, pre-filled syringe): 50 mg

Note: Option if anti-TNF withdrawn during 1st 6 months due to adverse effects 
Link  NICE TA 497: Golimumab for treating non-radiographic axial spondyloarthritis
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
   
Rituximab
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Second Choice
Red
High Cost Medicine

Concentrate for solution for infusion: 100 mg/10 mL, 500 mg/50 mL

Note: 2nd line with MTX on failure after 6 months of 1st line; or monotherapy if MTX contraindicated due to pulmonary fibrosis)


NTAG approved in combination with methotrexate as first-line biological therapy in cases where there is an absolute contraindication to tumour necrosis factor inhibitors


NTAG approved for 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

 
Link  NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
Link  NICE TA308: Rituximab in combination with glucocorticoids for treating anti-neutrophil cytoplasmic antibody-associated vasculitis
   
Etanercept
(Etanercept (subcutaneous 1st line with MTX))
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Formulary
Red

Injection (pre-filled syringe) (Enbrel) 25mg, 50mg

Injection (pre-filled syringe) (Benepali) 50mg

Injection (vial) (Enbrel) 25mg

Injection (paediatric) (Enbrel) 10mg, 25mg

 
Link  TA103 - For the treatment of adults with psoriasis
Link  TA 195 - For the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
Link  TA 199 - For the treatment of psoriatic arthritis
Link  TA 373 - For the treatment of juvenile idiopathic arthritis
Link  TA 375 - For the treatment of rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  TA 383 - For the treatment of ankylosing spondylitis and non-radiographic axial spondyloarthritis
   
Ixekizumab (Taltz)
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Formulary
Red
High Cost Medicine
 
Link  NICE TA 537 Ixekizumab for treating active psoriatic arthritis after inadequate response to DMARDs
   
Upadacitinib (Rinvoq)
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Formulary
Red
High Cost Medicine

MR tablet: 15 mg

 
Link  NICE TA 665: Upadacitinib for treating moderate to severe rheumatoid arthritis
   
Tocilizumab
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Alternatives
Red
High Cost Medicine

Concentrate for intravenous infusion: 80 mg/4 mL, 200 mg/10 mL, 400 mg/20 mL
Subcutaneous injection: 162mg/0.9mL (for rheumatoid arthritis only)

Note: 3rd line with MTX on failure after 6 months of 2nd line; or monotherapy if MTX contraindicated due to pulmonary fibrosis

 
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
Link  Tocilizumab for treating giant cell arteritis (TA518) 18.4.18
   
Abatacept
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Alternatives
Red
High Cost Medicine

IV infusion: 250 mg
Injection (pre-filled syringe): 125 mg (for rheumatoid arthritis only)

Note: 4th line with MTX on failure after 6 months of 3rd line

 
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: Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
   
Ustenkinumab
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Alternatives
Red
Solution for injection: 45mg 
Link  NICE TA180: Ustekinumab for the treatment of adults with moderate to severe psoriasis
Link  NICE TA340: Ustekinumab for treating active psoriatic arthritis
   
Secukinumab (Consentyx )
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Alternatives
Red
Injection: 150 mg/mL,
Pre-filled pen or pre-filled syringe: 150-mg  
Link  NICE TA350: Secukinumab for treating moderate to severe plaque psoriasis
Link  NICE TA407: Secukinumab for active ankylosing spondylitis after treatment with non-steroidal anti-inflammatory drugs or TNF-alpha inhibitors
   
Apremilast
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Alternatives
Red

Tablets: 30mg

 
Link  NICE TA433: Apremilast for treating active psoriatic arthritis
   
Belimumab (Benlysta )
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Alternatives
Red
High Cost Medicine

Vial for intravenous infusion: 120mg

 
Link  NICE TA397: Belimumab for treating active autoantibody-positive systemic lupus erythematosus
   
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
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

Drugs for hospital use or use by a specialist within specialist centre only. Initiation and monitoring of treatment should remain under the total responsibility of the appropriate hospital clinician or specialist. These drugs should only be prescribed under the direct supervision of that clinician or specialist and are not suitable for shared care arrangements. The drug should be supplied via the hospital or specialist centre for the duration of treatment.   

Amber

These are specialist drugs which must be initiated by secondary care specialist prescribers, but with the potential to transfer prescribing to primary care within written and agreed shared care protocols and according to the agreed process for transfer of care. For these drugs, in order to ensure patient safety, some aspects of care must remain with the specialist due to their complexity e.g. monitoring of disease or drug response. Other more routine aspects can be transferred to the GP e.g. monitoring of adverse effects and supply of the medicine. The specific responsibilities of the specialist and GP are defined in the shared care agreement for each drug. Shared care agreements are still under development for some amber drugs. Until these are available, it would be expected that any shared care request from secondary care to a GP would be accompanied by written information which defines prescribing and monitoring responsibilities. The hospital specialist should also provide the GP with enough information and support to allow the safe transfer and ongoing management of prescribing into primary care.   

Green +

Drugs which should usually be initiated in secondary care, or by a specialist clinician, 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.  

Green

These are defined as new and established drugs, which may be prescribed, initiated, changed or maintained on FP10 by the GP and, if appropriate, discontinued without recourse to secondary care. N.B. DRUGS NOT IDENTIFIED IN THE FORMULARY BY A RED, AMBER OR GREEN+ SYMBOL ARE CLASSIFIED AS GREEN.   

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