netFormulary Oxfordshire Clinical Commissioning Group NHS
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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
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
Cytotoxic Drug Azathioprine
(Rheumatology)
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Amber Shared Care Protocol

In line with Shared Care Protocol for:

  • Inflammatory arthritis in line with
  • Rheumatology in children and adolescents

APCO March 2016.

 
Link  UKMI Q&A: Can mothers breast feed while taking azathioprine?
   
Ciclosporin
(Rheumatology)
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Amber Shared Care Protocol

*Ciclosporin must be prescribed by BRAND NAME.*

In line with Shared Care Protocol for the treatment of:

  • Rheumatoid arthritis
  • Psoriatic arthritis, Behcet’s disease, myositis, systemic lupus erythematosus (all unlicensed)
  • In combination with other DMARDs such as methotrexate with careful monitoring.

APCO May 2015.

 
Link  UKMI Q&A: Brand name prescribing in primary care
   
Leflunomide
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Amber Shared Care Protocol

In line with Shared Care Protocol for:

  • Rheumatoid arthritis
  • Psoriatic arthritis
  • For paediatrics use in the treatment of inflammatory disorders including Juvenile Idiopathic Arthritis, psoriatic arthritis, non-bacterial osteomyelitis and uveitis.

APCO May 2015.

 
Link  MHRA advice: risk of hepatotoxicity, haemotoxicity, infections,& birth defects
   
Cytotoxic Drug Methotrexate 2.5mg tablets
(Rheumatology)
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Amber Shared Care Protocol

Only 2.5mg tablets should be prescribed and dispensed to avoid potentially fatal errors.

For use in adults and paediatrics line with Shared Care Protocol for:

  • Dermatology
  • Neurology
  • Gastroenterology
  • Respiratory

Rheumatology

For rheumatology please prescribe in line with Shared Care Protocol here. 

APCO September 2019

Opthalmology

For opthalmology (ocular inflammation) please prescribe in line with Shared Care Protocol here. 

APCO May 2019.

 
Link  UKMI Q&A: Interaction between methotrexate and penicillins
Link  UKMI Q&A: Methotrexate and alcohol guidance
   
Cytotoxic Drug Methotrexate injection (Metoject®)
(Rheumatology)
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Amber Shared Care Protocol

*Metoject® injection is the first choice brand of injection which should be used in Oxfordshire*

For use in adults and paediatrics line with Shared Care Protocol for:

  • Dermatology
  • Neurology
  • Gastroenterology
  • Respiratory

Rheumatology

For rheumatology please prescribe in line with Shared Care Protocol here. 

APCO September 2019

Opthalmology

For opthalmology (ocular inflammation) please prescribe in line with Shared Care Protocol here. 

APCO May 2019.

 

 
   
Abatacept (Orencia®)
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High Cost Medicine
BlueTeq

Red Traffic Light For the treatment of

  • Rheumatoid arthritis as per NICE TA195 (APCO September 2010) and NICE TA375 (APCO May 2013). Also see Clinical Commissioning Policy 201D.
  • Juvenile idiopathic arthritis as per NICE TA373. Funded by specialised commissioning. (APCO January 2016).

Black Traffic Light Not recommended for treating psoriatic arthritis after DMARDs (terminated appraisal) as per NICE TA568 (APCO May 2018). 

 
Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
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 TA568: Abatacept for treating psoriatic arthritis after DMARDs (terminated appraisal)
Link  Clinical Commissioning Statement: Biologics for Juvenile Idiopathic Arthritis
Link  NHS England: Suggested Treatment Flow-chart for JIA (Appendix A)
   
Adalimumab (Humira®)
(Rheumatology)
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Red
High Cost Medicine
BlueTeq

For the treatment of:

    • Ankylosing spondylitis and non-radiographic axial spondyloarthritis as per NICE TA383 (APCO March 2016).
    • Juvenile idiopathic arthritis as per NICE TA373 (APCO January 2016). Funded by specialised commissioning.
    • Rheumatoid arthritis as per NICE TA195 (APCO September 2010) and NICE TA375 (APCO March 2016). Also see Clinical Commissioning Policy 201D.
    • Psoriatic arthritis as per NICE TA199 (APCO September 2010). For sequential use please refer to Clinical Commissioning Policy 268A.

 

 
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  MHRA: Tuberculosis risk—screen patients before starting treatment
Link  Clinical Commissioning Statement: Biologics for Juvenile Idiopathic Arthritis
Link  Interim Clinical Commissioning Policy: Adalimumab for Children with Severe Refractory Uveitis
Link  NHS England: Suggested Treatment Flow-chart for JIA (Appendix A)
   
Anakinra (Kineret®)
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Restricted Drug Restricted
Red
High Cost Medicine
BlueTeq
  • For the treatment of juvenile idiopathic arthritis. Funded by specialised commissioning.
  • On the balance of its clinical benefits and cost effectiveness, anakinra is not recommended for the treatment of RA, except in the context of a controlled, long-term clinical study as per NICE CG79 (APCO May 2008).
  • Specialist prescribing only for Still's disease (APCO January 2020).
 
Link  NICE CG79: Rheumatoid arthritis in adults: management
Link  Clinical Commissioning Policy Statement: Biologic Therapies for the treatment of Juvenile Idiopathic Arthritis (JIA)
Link  NHS England: Suggested Treatment Flow-chart for JIA (Appendix A)
   
Baricitinib (Olumiant®)
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Red
High Cost Medicine
BlueTeq

For treating moderate to severe rheumatoid arthritis as per NICE TA466.

APCO September 2017.

 
Link  NICE TA466: Baricitinib for moderate to severe rheumatoid arthritis
   
Burosumab (Crysvita®)
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Red
High Cost Medicine
NHS England

For treating X-linked hypophosphataemia in children and young people as per NICE HST8.

Funded by specialised commissioning.

APCO November 2018.

 
Link  NICE HST8: Burosumab for treating X-linked hypophosphataemia in children and young people
   
Certolizumab Pegol (Cimzia®)
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Red
High Cost Medicine
BlueTeq

For treating:

  • Rheumatoid arthritis as per NICE TA186 (APCO March 2016).
  • Rheumatoid arthritis after inadequate response to a TNF-alpha inhibitor as per NICE TA415 (APCO November 2016).
  • With secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs as per NICE TA 445 (APCO July 2017). Funded by specialised commissioning.
  • For treating moderate to severe plaque psoriasis as per NICE TA574 (APCO May 2019). 

Also see Clinical Commissioning Policy 201D.

 
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 DMARDs
Link  NICE TA574: Certolizumab pegol for treating moderate to severe plaque psoriasis
Link  MHRA: Tuberculosis risk—screen patients before starting treatment
   
Etanercept (Enbrel®)
(Rheumatology)
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Red
High Cost Medicine
BlueTeq

For the treatment of:

    • Ankylosisng spondylitis and non-radiographic axial spondyloarthritis as per NICE TA383 (APCO March 2016).
    • Juvenile arthritis as per NICE TA35 (APCO January 2016). Funded by specialised commissioning.
    • Psoriatic arthritis as per NICE TA199 (APCO September 2010). For sequential use please refer to Clinical Commissioning Policy 268A.
    • Rheumatoid arthritis as per NICE TA375 (APCO March 2016) and TA195 (APCO September 2010). Also see Clinical Commissioning Policy 201D.

 

 
Link  NICE TA103: Etanercept and efalizumab for the treatment of adults with 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  MHRA: Tuberculosis risk—screen patients before starting treatment
Link  Clinical Commissioning Statement: Biologics for Juvenile Idiopathic Arthritis
Link  NHS England: Suggested Treatment Flow-chart for JIA (Appendix A)
   
Golimumab (Simponi®)
(Rheumatology)
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Formulary
Red
High Cost Medicine
BlueTeq

For the treatment of:

  • Psoriatic arthritis as per NICE TA220.  For sequential use please refer to Clinical Commissioning Policy 268A (APCO May 2011).
  • Rheumatoid arthritis as per NICE TA225 and NICE TA375. Also see Clinical Commissioning Policy 201D (APCO March 2011 and 2016).
  • Ankylosing spondylitis as per NICE TA383 (APCO March 2016). 
  • Non-radiographic axial spondyloarthritis as per NICE TA497 - Fast track (APCO February 2018).
 
Link  NICE TA220: psoriatic arthritis
Link  MHRA: Tuberculosis risk—screen patients before starting treatment
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
   
Infliximab
(Rheumatology)
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Red
High Cost Medicine
BlueTeq

For the treatment of:

    • Rheumatoid arthritis as per NICE TA195 (APCO September 2010) and NICE TA375 (APCO March 2016). Also see Clinical Commissioning Policy 201D.
    • Ankylosing spondylitis or severe non-radiographic axial spondyloarthritis as per NICE TA383 (APCO March 2016).
    • Psoriatic arthritis as per TA199 (APCO September 2010). For sequential use please refer to Clinical Commissioning Policy 268A.

 

 
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  MHRA: Tuberculosis risk—screen patients before starting treatment
Link  NHS England: Suggested Treatment Flow-chart for JIA (Appendix A)
Link  Clinical Commissioning Policy Statement: Biologic Therapies for the treatment of Juvenile Idiopathic Arthritis (JIA)
   
Ixekizumab (Taltz®)
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Red
High Cost Medicine
BlueTeq
  • For treating moderate to severe plaque psoriasis as per NICE TA442 (APCO July 2017).
  • For treating active psoriatic arthritis after inadequate response to DMARDs as per NICE TA537 (APCO September 2018).
 
Link  NICE TA442: Ixekizumab for treating moderate to severe plaque psoriasis
Link  NICE TA537: Ixekizumab for treating active psoriatic arthritis after inadequate response to DMARDs
   
Methotrexate injection (Nordimet®)
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Amber Shared Care Protocol

*Metoject® injection is the first choice in Oxfordshire*

Second line to metoject. For use in patients who are unable to use/ have compliance issues with metoject device.

APCO September 2019.

For use in adults and paediatrics line with Shared Care Protocol for:

  • Dermatology
  • Neurology
  • Gastroenterology
  • Respiratory

Rheumatology

For rheumatology please prescribe in line with Shared Care Protocol here. 

APCO September 2019

Opthalmology

For opthalmology (ocular inflammation) please prescribe in line with Shared Care Protocol here. 

APCO May 2019.

 
   
Rituximab  (MabThera®)
(Rheumatology)
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Red
High Cost Medicine
BlueTeq

For the treatment of:

    • Rheumatoid arthritis in adults after the failure of a TNF inhibitor as per NICE TA195. (APCO September 2010). Also see Clinical Commissioning Policy 201D.
    • For the treatment of juvenile idiopathic arthritis. Funded by specialised commissioning.

 

 
Link  NICE TA195: Rheumatoid arthritis - after failure of a TNF inhibitor
Link  Clinical Commissioning Policy Statement: Biologic Therapies for the treatment of Juvenile Idiopathic Arthritis (JIA)
Link  NHS England: Suggested Treatment Flow-chart for JIA (Appendix A)
Link  NHSE Commissioning Policy: Rituximab for ANCA-associated vasculitis in adults
   
Sarilumab (Kevzara®)
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Red
High Cost Medicine
BlueTeq

For moderate to severe rheumatoid arthritis as per NICE TA485.

APCO January 2018.

 
Link  NICE TA485: Sarilumab for moderate to severe rheumatoid arthritis
   
Tocilizumab (RoActemra®)
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Formulary
Red
High Cost Medicine
BlueTeq

For the treatment of:

    • Juvenile idiopathic arthritis as per NICE TA238 and TA373. Funded by specialised commissioning (APCO January 2012 and 2016).
    • Rheumatoid arthritis as per NICE TA247 (APCO March 2016). Also see Clinical Commissioning Policy 201B.
    • Takayasu arteritis as per NHSE Clinical Commissioning Policy 16056/P (Adults). Funded by specialised commissioning.
    • Giant cell arteritis as per NICE TA518. Funded by specialised commissioning (APCO May 2018). 
    • Still's disease. Funded by specialised commissioning (APCO January 2020).
 
Link  NICE TA247:Tocilizumab in RA
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  NHSE Clinical Commissioning Statement: Biologics for Juvenile Idiopathic Arthritis
Link  NHSE: Suggested Treatment Flow-chart for JIA (Appendix A)
   
Ustekinumab (Stelara®)
(Rheumatology)
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Formulary
Red
BlueTeq

For treating active psoriatic arthritis in line with NICE TA340.

For sequential use please refer to Clinical Commissioning Policy 268A.

APCO May 2017.

 
Link  NICE TA340: Ustekinumab for treating active psoriatic arthritis
   
10.01.03  Expand sub section  Cytokine modulators
10.01.03  Expand sub section  Sulfasalazine
 ....
 Non Formulary Items
Cytotoxic Drug  Methotrexate  (Ebetrex®)

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Non Formulary
Black

Please note that Metoject® is the first choice brand in Oxfordshire.

APCO May 2015.

 
  
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

Red

Red: Medicines which should only be prescribed in secondary care by a specialist.  

Amber Continuation

Amber Continuation: Medicines which should be initiated or recommended by a specialist for continuation in primary care. The specialist must notify the GP that the prescribing responsibility has been transferred.   

Amber Shared Care Protocol

Amber Shared Care Protocol: Medicines which are appropriate to be initiated and stabilised by a specialist, once stabilised the medicine may be appropriate for responsibility to be transferred from secondary to primary care with the agreement of a GP and a formal ‘shared care’ agreement. The shared care protocol must be approved by the Area Prescribing Committee Oxfordshire (APCO).   

Green

Green: Medicines which are suitable for initiation and ongoing prescribing within primary care.   

Brown

Brown: Medicines which should only be prescribed in restricted circumstances.  

Black

Black: Medicines which are not recommended for use because of lack of evidence of clinical effectiveness, cost effectiveness or safety.  

OCCG Green

not used  

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