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 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
Notes:

Prescribing Guidance

Please see our Prescribing Guidelines page for all prescribing guidance relating to this chapter.

Shared Care Agreements

Please see our Shared Care Agreements page for all shared care agreements (SCAs) relating to this chapter.

Self-care

Many of the products in this chapter are available for purchase over-the-counter, and patients are encouraged to self-care, with the support of their community pharmacist, in the first instance.

For further information on self-care & the NHS, please refer to https://www.england.nhs.uk/medicines/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed/

 Details...
10.01.03  Expand sub section  Drugs which suppress the rheumatic disease process
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
10.01.03  Expand sub section  Cytokine modulators to top
Abatacept (Orencia®)
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
CCG
BlueTeq
  • 250mg vial, powder for reconstitution. Injection 125mg pre-filled syringe
  • Commissioned by CCG for:
    • The treatment of rheumatoid arthritis in line with NICE TA195, TA375.
  •  Commissioned by NHS England From Specialist Centres Only for:
    • Juvenile idiopathic arthritis in line with NICE TA373.
    • Paediatric indications where an adult NICE TA is available.
  • Check individual Trust contracting arrangements.

 

 
Link  NICE TA195 August 2010: 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
(Imraldi®Amgevita®Humira®)
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
CCG
BlueTeq
  • Injection 40mg prefilled syringe, prefilled pen
  • Prescribe by brand. Biosimilar first-line option.  Imraldi® first line biosimilar across BSW
  • For rheumatoid arthritis in accordance with NICE TA375.
  • Commissioned by NHS England From Specialist Centres Only for:
    • Juvenile idiopathic arthritis in line with NICE TA373.
    • Paediatric indications where an adult NICE TA is available
  • Check Trust contracting arrangements.

 

 
Link  MHRA DSU April 2014: Tumour necrosis factor alpha inhibitors: risk of tuberculosis—screen all
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
 
Belimumab (Benlysta® )
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
BlueTeq
  • Intravenous infusion, powder for reconstitution 120mg vial; 400mg vial
  • Commissioned by NHSE at specialist centres e.g RUH
  • Non Formulary at GWH and SFT 
 
Link  NICE TA397: Belimumab for treating active autoantibody-positive systemic lupus erythematosus
Link  MHRA Drug Safety Update (Apr 2019):Belimumab (Benlysta¥): increased risk of serious psychiatric events seen in clinical trials
 
Certolizumab Pegol
(Cimzia®)
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
CCG
BlueTeq
  • Prefilled syringe 200mg.
  • Use in accordance with NICE guidance and local pathways for RA, AS or PSA.
  • Not routinely commissioned by NHS England for paediatric indications - see NHS England drugs list. 

 

 

 
Link  MHRA DSU April 2014: Tumour necrosis factor alpha inhibitors: risk of tuberculosis—screen all
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 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
 
Etanercept
(Benepali®, Enbrel®,Erelzi® )
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
CCG
BlueTeq
  • 25mg or 50mg solution for injection in pre-filled syringe or pen
  • Prescribe by BRAND. Biosimilar should be used 1st line. BENEPALI® is the biosimilar brand used locally in BSW. First-line etanercept brand. 

Commissioned by CCG for:

  • Rheumatoid arthritis in accordance with NICE TA 375 and local pathway.
  • Ankylosing spondylitis in accordance with NICE TA383 and local pathway
  • Psoriatic arthritis in accordance with NICE TA199 and local pathway

Commissioned by NHS England from specialist centres only for:

  • Juvenile idiopathic arthritis in line with NICE TA373.
  • Paediatric patients in line with adult NICE TAs.
  • Check Trust contracting arrangements.

 

 
Link  MHRA DSU April 2014: Tumour necrosis factor alpha inhibitors: risk of tuberculosis—screen all
Link  NICE TA195: rheumatoid arthritis after the 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
 
Golimumab (Simponi®)
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
CCG
BlueTeq
  • 50mg or 100mg pre-filled pen or syringe
  • Commissioned by NHS England for paediatric indications.
  • Commissioned by CCG for:
    • Psoriatic arthritis in accordance with NICE TAs and local pathway.
    • Rheumatoid arthritis in accordance with NICE TAs and local pathway.
    • Ankylosing spondylitis in accordance with NICE TAs and local pathway.
 
Link  MHRA DSU April 2014: Tumour necrosis factor alpha inhibitors: risk of tuberculosis—screen all
Link  NICE TA220 April 2011: Golimumab for the treatment of psoriatic arthritis
Link  NICE TA375 January 2016: 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 February 2016: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
Link  NICE TA497: Golimumab for treating non-radiographic axial spondyloarthritis
 
Infliximab
(Remsima®Inflectra®Remicade®)
(Infusion)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
CCG
BlueTeq
  • 100mg powder for concentrate for solution for infusion
  • All products should be prescribed by brand. Biosimilars should be used 1st line.
  • For rheumatoid arthritis in accordance with NICE recommendations TA130 and TA195 and local pathway.
  • For ankylosing spondylitis in accordance with NICE TA145 and TA140 and local pathway.
  • For psoriatic arthritis in accordance with NICE TA199 and local pathway.
  • Commissioned by NHS England for paediatric indications (where adult TA available). According to adult TAs (TA130, TA134, TA140, TA143, TA163, TA199) for the range of arthritis-related indications. 
  • Check Trust contracting arrangements first before prescribing 
  • Not routinely commissioned by NHS England for: connective tissue disease - interstitial lung disease, graft versus host disease, renal indications, sarcoidosis, progressive pulmonary sarcoidosis, uveitis or hidradenitis suppurativa.  

 

 
Link  MHRA DSU April 2014: Tumour necrosis factor alpha inhibitors: risk of tuberculosis—screen all
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
 
Ixekizumab (Taltz®)
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
CCG
BlueTeq
  • 80mg solution for injection in pre-filled syringe or pen
  • CCG commissioned as per NICE TA537 for psoriatic arthritis
 
Link  NICE TA537 August 2018: Ixekizumab for treating active psoriatic arthritis after inadequate response to DMARDs
 
Rituximab
(MabThera®,Truxima®)
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
CCG
BlueTeq
  • 100mg or 500mg concentrate for solution for infusion
  • All products should be prescribed by brand. Biosimilars should be used where possible.
  • CCG commissioned as per NICE TA195 for Rheumatoid Arthritis
  • In accordance with NHS England policies only from specialist centres for:
    • paediatric rheumatology indications where adult TA is available (TA195).
    • ANCA-positive vasculitis as per NICE TA308 and NHS England Policy: A13/P/a.
    • SLE as per NHS England Policy: A13/PS/a.
    • Dermatomyositis and polymyositis.
    • Neuromyelitis optica, as per specification.
    • ABO-incompatible kidney transplants, as per specification.
    • Myasthenia gravis as per NHSE policy 170084P (Restricted Item specialist centres only).
  • Check Trust contracting arrangements first before prescribing
 
Link  NHSE 2018: Clinical Commissioning Policy Statement: Rituximab bio-similar for the treatment of myasthenia gravis (adults)
Link  NHSE July 2016: Clinical Commissioning Policy: Rituximab for the treatment of dermatomyositis and polymyositis (adults)
Link  NHSE September 2013 Interim Clinical Commissioning Policy Statement: Rituximab for the treatment of Systemic Lupus Erythematosus in adults
Link  NICE TA195 August 2010: Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
Link  NICE TA308 March 2014: Rituximab in combination with glucocorticoids for treating anti-neutrophil cytoplasmic antibody-associated vasculitis
Link  Safety Letter April 2013: Direct Healthcare Professional Communication on the association of MabThera® (rituximab) with Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome
 
Sarilumab (Kevzara®)
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
CCG
BlueTeq
  • 150 mg or 200mg solution for injection in pre-filled syringe
  • 150 mg or 200mg solution for injection in pre-filled pen
  • Commissioned by NHS England for:
    • For patients admitted to ICU with COVID-19- see link below.

 

 
Link  NHSE Interim Position Statement: Interleukin-6 inhibitors (tocilizumab or sarilumab) for patients admitted to ICU with COVID-19 pneumonia (adults) Nov 2020
Link  NICE TA485: Sarilumab for moderate to severe rheumatoid arthritis
 
Secukinumab (Cosentyx®)
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
CCG
BlueTeq
  • 150 mg solution for injection in pre-filled syringe or pen
 
Link  NICE TA407 September 2017: Secukinumab for active ankylosing spondylitis after treatment with non-steroidal anti-inflammatory drugs or TNF-alpha inhibitors
Link  NICE TA445 May 2017: Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs
 
Tocilizumab (RoActemra®)
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
CCG
BlueTeq
  • 162mg solution for injection in pre-filled syringe or pen.
  • 20mg/ml concentrate for solution for infusion

Commissioned by CCG for:

  • treating rheumatoid arthritis in line with NICE TA375

Commissioned by NHS England for:

  • For patients admitted to ICU with COVID-19- see link below.
  • Juvenile idiopathic arthritis in line with NICE TA238 and TA373.
  • Giant cell arteritis in line with NICE TA518 (specialist centres/networks only)
  • Adult-Onset Still’s Disease refractory to second-line therapy in line with clinical commissioning policy 170056P (specialist centres/networks only).
  • Check Trust contracting arrangements first before prescribing

 

 
Link  NHSE Interim Position Statement: Interleukin-6 inhibitors (tocilizumab or sarilumab) for patients admitted to ICU with COVID-19 pneumonia (adults) Nov 2020
Link  MHRA Drug Safety Update (Jul 2019):Tocilizumab (RoActemra): rare risk of serious liver injury including cases requiring transplantation
Link  Letter to HCP June 2019 - Rare risk of serious hepatic injury including acute liver failure requiring transplantation
Link  NICE TA238 December 2011: Tocilizumab for the treatment of systemic juvenile idiopathic 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
 
Ustekinumab (Stelara®)
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
CCG
BlueTeq
  • 45mg/90mg pre-filled syringe or 45mg solution for injection (vials)
  • Rheumatology
  • CCG commissioned for for the treatment of active psoriatic arthritis in accordance with NICE TA340
 
Link  NICE TA340 March 2017 update: Ustekinumab for treating active psoriatic arthritis
Link  Policy for dose escalation of Ustekinumab in psoriasis or psoriatic arthritis (outside of NICE)
 
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
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

Traffic LightRed

RED - Hospital only – to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  

Traffic LightAmber

Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Traffic LightAmber with Shared Care

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

Traffic LightGreen

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  

Traffic LightSelf

Suitable for patient to be directed to buy themselves  

Traffic LightGrey

Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   

Traffic LightBlack

(In use from Oct 2020) Used where a decision has been made by the BSW APC not to routinely commission this preparation for its licensed indications. Do not prescribe.   

Traffic LightRed Specialist Centre

Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.  

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