netFormulary NHS
Pan Mersey
Area Prescribing Committee
 Search
 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
Notes:

Review date: October 2022

Non-formulary drugs: Any drug or formulation not listed in the formulary is deemed to be non-formulary.

Off-label use: Drugs are included in the formulary for their licensed indications – where inclusion of off-label use is considered to be included in the formulary this is specifically stated in the formulary entry for the drug N.B. also see Paediatrics note below.

Paediatrics: Drugs are included in the formulary for paediatric use for their BNF for Children recommended indications (indicated by symbol View childrens BNF) which may be off-label, unless otherwise stated. All drugs are deemed to have the same RAG status as they have for adults unless stated otherwise.

NHS England Specialised Commissioning
Drugs carrying the NHS England logo are commissioned by them. Links to key documents, national programmes of care, and clinical reference groups are found below.

NHSE NHS England Specialised Commissioning: Key documents

NHSE NHS England Specialised Commissioning: National programmes of care and clinical reference groups

Chapter Links...
 Details...
10.01.03  Expand sub section  Drugs which suppress the rheumatic disease process
 note  Consult any local prescribing arrangements for shared-care prescribing of these drugs
10.01.03  Expand sub section  Gold
10.01.03  Expand sub section  Penicillamine
10.01.03  Expand sub section  Antimalarials
10.01.03  Expand sub section  Drugs affecting the immune response to top
10.01.03  Expand sub section  Cytokine modulators
 note 

Cytokine modulators should be prescribed only in accordance with the criteria outlined in the respective NICE technology appraisal, Pan-Mersey APC statement or NHS England Clinical Commissioning Policy Statement.

NHSE NHSE drug: cytokine modulators in paediatric conditions (where adult TA available) are commissioned by NHS England

NICE has produced a Commissioning Support guide for each condition as a tool to aid the implementation of NICE guidance on biologic drugs for the treatment of inflammatory disease (see chapter link).

Abatacept
View adult BNF View SPC online View childrens BNF
Formulary
Red

IV infusion 250 mg vial (powder for reconstitution), subcutaneous injection 125mg (pre-filled syringe)
NHS NHSE commissioned drug for some indications - see Specialised Commissioning: Key documents

Grey for Psoriatic Arthritis (NICE TA terminated March 2019)

 
Link  NICE TA568: Abatacept for treating psoriatic arthritis after DMARDs (terminated appraisal)
Link  Pan Mersey APC (2018). Abatacept infusion and subcutaneous injection (Orencia®) in rheumatological conditions
   
Adalimumab
View adult BNF View SPC online View childrens BNF
Formulary
Red

Subcutaneous injection 40 mg (prefilled pen or prefilled syringe)
NHS NHSE commissioned drug for some indications - see Specialised Commissioning: Key documents

Amgevita® biosimilar brand

Hulio® biosimilar brand

Hyrimoz® biosimilar brand

Imraldi® biosimilar brand

Humira® originator brand  

Prescribe by brand name

 
Link  Pan Mersey (2018). ADALIMUMAB injection (Humira®) in rheumatological conditions
   
Alemtuzumab
View adult BNF View SPC online
Formulary
Red

Concentrate for intravenous infusion 10mg/mL 1.2mL vial
NHS NHSE commissioned drug for some indications - see Specialised Commissioning: Key documents

Paediatrics: no BNFc entry - seek specialist advice

 
   
Baricitinib
View adult BNF View SPC online
Formulary
Red

Film-coated tablets 2mg, 4mg (Olumiant ®)

Paediatrics: no BNFc entry - seek specialist advice

 
Link  NICE (2017). Baricitinib for moderate to severe rheumatoid arthritis [TA466]
   
Belimumab
View adult BNF View SPC online
Formulary
Red

IV infusion 120mg, 400mg powder for solution

NHS NHSE commissioned for systemic lupus erythematosus

Paediatrics: no BNFc entry - seek specialist advice

 
Link  NICE (2016). Belimumab for treating active autoantibody-positive systemic lupus erythematosus [TA397]
   
Certolizumab pegol
View adult BNF View SPC online
Formulary
Red
Subcutaneous injection 200 mg (prefilled syringe, prefilled pen)

Paediatrics: no BNFc entry - seek specialist advice
 
Link  Pan Mersey APC (2018). CERTOLIZUMAB injection (Cimzia®) in rheumatological conditions
Link  NICE (2017). Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs [TA445]
   
Etanercept
View adult BNF View SPC online View childrens BNF
Formulary
Red

Subcutaneous injection 10mg, 25mg vial (powder for reconstitution) and 25 mg, 50 mg (prefilled syringe) and 50mg (prefilled pen)

Enbrel® - Originator brand

Erelzi®,biosimilar brand 
Benepali® - Biosimilar brand

Prescribe by brand

NHS NHSE commissioned drug for some indications - see Specialised Commissioning: Key documents

 
Link  Pan Mersey (2018). ETANERCEPT injection (Enbrel®, Benepali®▼) in rheumatological conditions
   
Golimumab
View adult BNF View SPC online
Formulary
Red

Subcutaneous injection 50 mg prefilled pen or prefilled syringe, 100mg prefilled pen
Paediatrics: no BNFc entry - seek specialist advice

NHS NHSE commissioned drug for some indications - see Specialised Commissioning: Key documents

 
Link  Pan Mersey APC (2018). Golimumab injection (Simponi®) in rheumatological conditions
Link  NICE (2018). Golimumab for treating non-radiographic axial spondyloarthritis [TA497]
   
Infliximab
View adult BNF View SPC online
Formulary
Red
IV infusion 100 mg (powder for reconstitution)
Remicade® - Originator Brand
Flixabi ®, Inflectra®, Remsima® - Biosimilar Brands

Prescribe by brand

NHS NHSE commissioned drug for some indications - see Specialised Commissioning: Key documents

Paediatrics: no BNFc entry - seek specialist advice 
Link  Pan Mersey APC (2018). INFLIXIMAB infusion (Remicade®, Inflectra®▼, Remsima®▼) in rheumatological conditions
Link  MHRA (2014). Biosimilar products
Link  NICE (2016). Biosimilars medicines: options for local implementation [KTT15]
Link  SPS (2015). LMEN Review: Answers to commonly asked questions about biosimilar versions of infliximab
   
Ixekizumab
View adult BNF View SPC online
Formulary
Red

80mg solution for injection prefilled syringe; prefilled pen

Psoriatic Arthritis

No BNFc entry; Paediatrics, seek specialist advice 

 
Link  NICE TA537 (2018): Ixekizumab for treating active psoriatic arthritis after inadequate response to DMARDs
Link  Pan Mersey APC (2018). IXEKIZUMAB solution for injection (Taltz®▼) for Psoriatic Arthritis
   
Rituximab
View adult BNF View SPC online
Formulary
Red

IV infusion 10 mg/mL, 10ml and 50ml vials 

Originator brand: MabThera®

Biosimilar brands: Truxima®, Rixathon®

Prescribe by brand.

Paediatrics: no BNFc entry - seek specialist advice

NHS NHSE commissioned drug for some indications - see Specialised Commissioning: Key documents

 
Link  Pan Mersey APC (2017). RITUXIMAB infusion in Rheumatoid Arthritis (RA)
Link  NICE (2010). Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor [TA195]
   
Sarilumab
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Red

Solution for injection 150mg, 200mg (pre-filled pen; pre-filled syringe)

Rheumatoid arthritis

Paediatrics: no BNFc entry - seek specialist advice

 
Link  NICE (2017). Sarilumab for moderate to severe rheumatoid arthritis [TA485]
   
Secukinumab
View adult BNF View SPC online
Formulary
Red

150mg solution for injection (Cosentyx ®)
prefilled syringe; prefilled pen

For Ankylosing Spondylitis & Psoriatic Arthritis

Paediatrics: no BNFc entry - seek specialist advice
 

 
Link  NICE (2016). Secukinumab for active ankylosing spondylitis after treatment with non-steroidal anti-inflammatory drugs or TNF-alpha inhibitors [TA407]
Link  NICE (2017). Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs [TA445]
   
Tocilizumab
View adult BNF View SPC online View childrens BNF
Formulary
Red

IV infusion 20 mg/mL, Subcutaneous injection 162mg prefilled syringe and pen

NHS NHSE commissioned drug for some indications - see Specialised Commissioning: Key documents

 
Link  Pan Mersey APC (2018). Tocilizumab (RoActemra®) in rheumatological conditions
   
Tofacitinib
View adult BNF View SPC online
Formulary
Red

Film-coated tablets 5mg (Xeljanz®)

Paediatrics: No BNFc entry - seek specialist advice

 

 
Link  Pan Mersey APC (2018). TOFACITINIB film-coated tablets (Xeljanz®▼) for Psoriatic Arthritis
Link  NICE (2017).Tofacitinib for moderate to severe rheumatoid arthritis [TA480]
Link  NICE TA543:Tofacitinib for treating active psoriatic arthritis after inadequate response to DMARDs
   
Ustekinumab
View adult BNF View SPC online View childrens BNF
Formulary
Red

Subcutaneous injection 45mg, 90mg prefilled syringes and 45mg/0.5ml vials

 

for psoriatic arthritis

 
Link  Pan Mersey APC (2017). USTEKINUMAB injection (Stelara®) for Psoriatic Arthritis
Link  NICE (2015). Ustekinumab for treating active psoriatic arthritis [TA340]
   
Anakinra
View adult BNF View SPC online View childrens BNF
Formulary
Black

Subcutaneous injection100mg prefilled syringe

for rheumatoid arthritis

NHS NHSE commissioned drug for some indications - see Specialised Commissioning: Key documents
Red  for Adult Onset Still's Disease, as per Pan Mersey protocol - see links below.

 
Link  Pan Mersey APC (2016), STILL’S DISEASE, biological agents in adult onset
Link  Pan Mersey APC (2016), STILL’S DISEASE, adult onset treatment pathway
Link  NICE (2009). Rheumatoid arthritis in adults: management [CG79]
   
Apremilast
View adult BNF View SPC online
Formulary
Red

Tablets 10mg, 20mg, 30mg (Otezla®)

In line with NICE TA433 - Apremilast for treating active psoriatic arthritis

Paediatrics: no BNFc entry - seek specialist advice

 
Link  NICE TA433: Apremilast for treating active psoriatic arthritis(replaces TA372)
   
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 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

Traffic Light Status Information

Status Description

Green

Medicines considered suitable for non-specialist prescribing in primary or secondary care.  

Amber Recommended

Requires specialist assessment to enable patient selection.  Amber Recommended medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Following specialist assessment, the medicine is suitable for prescribing in Primary Care.  

Amber Initiated

Amber Initiated. Requires specialist initiation of prescribing. Prescribing to be continued by the specialist until stabilisation of the dose is achieved and the patient has been reviewed. Amber Initiated medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patient’s dose and condition is stable   

Amber Retained

Amber Patient Retained. Requires specialist initiation of prescribing. Prescribing to be continued by specialist until stabilisation of the dose is achieved and the patient had been reviewed. Patient remains under the care of specialist (ie not discharged) as occasional specialist input may be required. Amber Patient Retained medicines must meet criteria: (1)Requires specialist assessment to enable patient selection (2)Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patient’s dose and condition is stable (4) May require occasional specialist input indefinitely and therefore the patient should not be discharged from specialist care   

Amber

Medicines recommended or initiated by specialists in primary or secondary care. Non-specialist prescribing in primary care may follow according the RAG criteria. In process of being superceded by Amber Recommended, Amber Initiated and Amber Patient Retained.  

Purple

Shared Care. Medicines are considered suitable for Primary Care prescribing and/or management, following specialist initiation of therapy, with on-going communication between the Primary Care prescriber and specialist, within the framework of a Shared Care Agreement. Medicines designated as requiring Shared Care require on-going input from both Specialist and Primary Care clinicians and patients should not be discharged from Specialist care. Where prescribing and monitoring are required under shared care, it is implicit that the responsibility for both of these tasks rests with the prescriber. A Shared Care Agreement will always be available for Shared Care medicines and this document will include a Shared Care Agreement pro-forma which will be completed by all involved clinicians. This pro-forma will record agreement to take on defined aspects of care e.g. monitoring and/or on-going prescribing for the individual patients. A policy detailing clinician responsibilities in Shared Care Agreements must be referred to in all cases of Shared Care. All drugs to be included in this category must meet Shared Care criteria 1 to 3: SC1 Requires specialist assessment to enable patient selection and also initiation, stabilisation and review of treatment and the patient`s condition. SC2 Prescribing and/or management of the drug in Primary Care with specialist support and input, within the framework of the Shared Care Agreement is safe and convenient and that there is an appropriate mechanism for individual patient access in Primary Care. SC3 Requires specific long-term monitoring (blood test or other measurement) for adverse effects and / or efficacy of the drug to be completed in Primary Care, and requires on-going specialist support for the dose changes or management of adverse effects. Monitoring is required on a regular basis (typically four times a year). Implicit in any shared care agreement is the understanding that participation is at the discretion of the Primary Care prescriber subject to their clinical confidence.   

Red

Primary care prescribing of these medicines is NOT recommended. These treatments should be initiated by specialists only; ongoing prescribing is retained within secondary care.   

Black

Not recommended for use. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist.   

Grey

Not recommended for use at this time. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist. Further guidance will be issued when more information or evidence is made available.  

netFormulary