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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
10.01.03  Expand sub section  Gold
Sodium Aurothomalate (Myocrisin«)
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Formulary
Amber
Injection 
   
10.01.03  Expand sub section  Penicillamine
Penicillamine
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Formulary
Amber
Tablets 
   
10.01.03  Expand sub section  Antimalarials
Hydroxychloroquine
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Formulary
Amber
Tablets 
   
10.01.03  Expand sub section  Drugs affecting the immune response to top
Apremilast (Otezla« )
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Formulary
Red
Tablets 
Link  NICE TA433: Apremilast for treating active psoriatic arthritis
   
Cytotoxic Drug Azathioprine
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Formulary
Amber
Tablets 
   
Baricitinib (Olumiant«)
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Red
High Cost Medicine

Tablets

 
Link  NICE TA466: Baricitinib for moderate to severe rheumatoid arthritis
   
Ciclosporin
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Formulary
Amber
Capsules

Prescribe by brand
 
   
Cytotoxic Drug Cyclophosphamide
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Red
Tablets
Injection 
   
Leflunomide
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Formulary
Amber
Tablets

Restricted Item Specialist Initiation Only 
   
Cytotoxic Drug Methotrexate
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Formulary
Amber
Tablets
Pre-filled injection pen (supplied to patients via homecare arrangements)

Restricted ItemáSpecialist initiation only

WEEKLY dosing
 
Link  NPSA Alert, June 2006: Improving compliance with oral methotrexate guidelines
   
Mycophenolate
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Formulary
Amber
Tablets
Capsules


unlicensedunlicensed indication (rheumatoid arthritis).  
Link  MHRA Safety Alert: Contraception advice for male patients
Link  MHRA Safety Update: Pregnancy prevention advice
   
Tofacitinib (Xeljanz)
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Formulary
Red
High Cost Medicine
BlueTeq

Tablets

 
Link  NICE TA480: Tofacitinib for moderate to severe rheumatoid arthritis
   
10.01.03  Expand sub section  Biologics
 note  Biologics can be used, without prior funding approval, according to GMMMG-approved pathways: Harmonised Biologics Pathway for Rheumatoid Arthritis and Harmonised Biologics Pathway for Ankylosing Spondylitis and Psoriatic Arthritis
Abatacept
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Red
Homecare

Intravenous infusion

 
   
Adalimumab  (Amgevita«) (BIOSIMILAR)
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Formulary
Red
Homecare
BlueTeq

Subcutaneous Injection

 
   
Adalimumab (Humira«)
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Formulary
Red
Homecare
BlueTeq

Subcutaneous Injection

 
Link  MHRA Drug Safety Update, April 2014: TNF alpha inhibitors: Risk of tuberculosis - screen all patients before starting treatment and monitor them closely.
Link  NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
   
Certolizumab Pegol
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Formulary
Red
Homecare

Subcutaneous Injection

 
Link  MHRA Drug Safety Update, April 2014: TNF alpha inhibitors: Risk of tuberculosis - screen all patients before starting treatment and monitor them closely.
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 TA415: Certolizumab pegol for treating rheumatoid arthritis after inadequate response to a TNF-alpha inhibitor
   
Etanercept (Benepali« )
(BIOSIMILAR)
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Red
Homecare

Subcutaneous Injection



  • New patients only

 
Link  GMMMG Guidance: Prescribing Biosimilar Biologic Medicines
Link  GMMMG Recommendation: Etanercept biosimilar (Benepali)
Link  UKMi Q&A: What are biosimilar medicinal products?
   
Etanercept (Enbrel«)
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Formulary
Red
Homecare

Subcutaneous Injection



 
Link  MHRA Drug Safety Update, April 2014: TNF alpha inhibitors: Risk of tuberculosis - screen all patients before starting treatment and monitor them closely.
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 TA35: Arthritis (juvenile idiopathic) - etanercept
   
Golimumab
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Formulary
Red
Homecare

Subcutaneous Injection

 
Link  MHRA Drug Safety Update, April 2014: TNF alpha inhibitors: Risk of tuberculosis - screen all patients before starting treatment and monitor them closely.
Link  NICE TA220: Psoriatic arthritis - golimumab
Link  NICE TA225: Rheumatoid arthritis - golimumab
Link  NICE TA233: Ankylosing spondylitis - golimumab
   
Infliximab
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Formulary
Red
Intravenous Infusion 
Link  MHRA Drug Safety Update, April 2014: TNF alpha inhibitors: Risk of tuberculosis - screen all patients before starting treatment and monitor them closely.
Link  NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
Link  NICE TA199: Psoriatic arthritis - etanercept, infliximab and adalimumab
   
Rituximab
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Formulary
Red
Intravenous Infusion 
Link  MHRA Drug Safety Update December 2009: Rituximab: progressive multifocal leukoencephalopathy in a patient without prior treatment for RA
Link  MHRA Drug Safety Update, December 2013: Rituximab: screen for hepatitis B virus before treatment
Link  NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
   
Sarilumab (Kavzara«)
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Formulary
Red

Pre-filled syringe or pen

 
Link  NICE TA485: Sarilumab for moderate to severe rheumatoid arthritis
   
Secukinumab (Cosentyx«)
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Formulary
Red
Homecare

Pre-filled syringe

 
Link  NICE TA445: Secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs
   
Tocilizumab
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Formulary
Red
Intravenous preparation ONLY

(Subcutaneous preparation is currently non-formulary) 
Link  NICE TA198: Rheumatoid arthritis - tocilizumab
Link  NICE TA518: Tocilizumab for treating giant cell arteritis
   
Ustekinumab
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Red
Homecare

Subcutaneous Injection


Approved for use as per NICE TA340, i.e.:

Ustekinumab is recommended as an option, alone or in combination with methotrexate, for treating active psoriatic arthritis in adults only when:
• treatment with TNF alpha inhibitors is contraindicated but would otherwise be considered (as described in NICE guidance on etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis and golimumab for the treatment of psoriatic arthritis)
• or the person has had treatment with 1 or more TNF–alpha inhibitors.

Ustekinumab is recommended only if the company provides the 90mg dose of ustekinumab for people who weigh more than 100 kg at the same cost as the 45mg dose, as agreed in the patient access scheme.

 
Link  NICE TA340: Ustekinumab for treating active psoriatic arthritis
   
10.01.03  Expand sub section  Sulfasalazine
Sulfasalazine
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Formulary
Amber
Enteric coated tablets 
   
 ....
 Non Formulary Items
Anakinra

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Non Formulary
Red
 
Auranofin  (Ridaura«)

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Non Formulary
 
Belimumab

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Non Formulary
Red
GMMMG recommends that belimumab may be used only when commissioned by NHS England
 
Chloroquine

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Non Formulary
 
Tocilizumab

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Non Formulary
Red
Subcutaneous injection

Supplied via homecare arrangements

 
  
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
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Link to children's BNF
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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

Amber

Drugs designated amber are suitable for shared care arrangements under a shared care protocol. Prescribing may be transferred from secondary to primary care once the patient is stabilised and agreed shared care arrangements have been established. Alternatively primary care may initiate under the supervision of secondary care if this option is given in the shared care document. It is recommended that shared care arrangements should be drawn up following local discussion and agreement by prescribing parties.   

Black

These products have been reviewed by the GM Joint Formulary Group and have been deemed not suitable for prescribing for adults in primary or secondary care within Greater Manchester. These decisions have been made on the basis of safety, efficacy and cost-effectiveness of the products.  

Green

Not used   

Green 1

Drugs designated green1 are suitable for initiation and ongoing prescribing within primary care.   

Green 2

Drugs designated green2 can be initiated by primary care following written or verbal advice from a specialist and then be subsequently safely prescribed in primary care with little or no monitoring required.  

Green 3

Drugs designated green3 are suitable for on-going prescribing within primary care after specialist initiation and an initial review (unless specified) in secondary care. Little or no monitoring is required.  

Grey

Not suitable for routine prescribing but may be suitable for a defined patient population. Whilst prescribers should think very carefully before prescribing or recommending any of the products on the grey list, there may be exceptional instances when the use of one of these products is necessary for a particular patient.   

Red

Drugs designated red are considered to be specialist medicines and prescribing responsibility for these medicines should normally remain with the consultant or specialist clinician. These drugs should not be initiated or prescribed in primary care. It is recommended that the supply of these specialist medicines should be organised via the hospital pharmacy, this may include arranging for supply via a home care company.   

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