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Updates following the April Area Prescribing Committee Meeting

 

Red, Amber, Green Classifications:

•Darbopoetin –Agreement amongst members to classify as RED for all indications

•Benzbromarone – Indication: Gout – RED

•Nitazoxanide – Indication:

Unlicensed in UK, licensed in US for treatment of Cryptosporidiosis and Giardiasis –  RED

•Ferrinject – Indication:

Heart failure patients with or without decreased haemoglobin levels – RED

•Tofacitinib – Indication:

XELJANZ® in combination with methotrexate (MTX) is indicated for the treatment of moderate to severe active rheumatoid arthritis (RA) in adult patients who have inadequately responded to, or who are intolerant to, one or more disease-modifying antirheumatic drugs (DMARDs). XELJANZ® can be given as monotherapy in case of intolerance to MTX or when treatment with MTX is inappropriate –  RED

•Ixazonib – Indication:

Ixazomib in combination with lenalidomide and dexamethasone is indicated for the treatment of adult patients with multiple myeloma who have received at least one prior therapy – RED

•Daratumunab – Indication:

As monotherapy for the treatment of adult patients with relapsed and refractory multiple myeloma, whose prior therapy included a proteasome inhibitor and an immunomodulatory agent and who have demonstrated disease progression on the last therapy. In combination with lenalidomide and dexamethasone, or bortezomib and dexamethasone, for the treatment of adult patients with multiple myeloma who have received at least one prior therapy – RED

•Safinamide – Indication:

Parkinson’s disease, as an adjunct to levodopa alone or in combination with other antiparkinsonian drugs, for mid- to late-stage fluctuations – GSI.

 

Prescribing Guidelines:

•The Baby milk guidelines have been approved and the updated version is now uploaded onto the website for information.

 

Shared Care Guidelines:

•Lithium – Following the minor changes required. Agreement to approve as chairs action outside of the meeting once the changes have been made.

 

For information:

 A bulletin around benzodiazepines and the risk of suicide has been added to the Mental Health and Medicines Alerts and Safety Issues sections of the website.

 

The ratified minutes from the February meeting have been added to the business section of the website for information.

 


March 2018 APC update:

Interim Commissioning Position – Flash Glucose Monitoring Systems – Updated March 2018

The expected cost of the Flash Glucose Monitoring Systems to the NHS is over £900 per patient per year of continuous use compared with £360 – £650 per patient per year for finger pricking (based on testing 4-8 times per day). Therefore, it is currently unaffordable and unsustainable to make it available for all people with diabetes.

Work is ongoing between the six CCGs within the South West Yorkshire Area Prescribing Committee (Bradford City and Districts CCGs, Calderdale CCG, Greater Huddersfield CCG, North Kirklees CCG, Wakefield CCGs) and diabetes specialists to agree which groups of patients would gain most health benefit from using Flash Glucose Monitoring Systems, whilst keeping it affordable for the NHS.

There is also a need to consider our neighbouring heath economies to ensure consistency of care across a wider footprint, and therefore we have to take account of how neighbouring CCGs and health economies are managing this device.

The current situation re: Flash Glucose Monitoring Systems is that they are not routinely commissioned, and any requests for use need to go through the IFR process where the patient exhibits exceptionality. Patients currently using this system in the meantime should continue to self-fund; GPs should not initiate any prescriptions for Flash Glucose Monitoring Systems.

Any change to this position will be communicated to GPs as soon as an agreement is reached, and the website will be updated to reflect this.

We have put together a list of some frequently asked questions which you can find here.

 

Items which should not routinely be prescribed in Primary Care: Guidance for CCGs

Following the publication of the above NHSE guidance to CCGs; the SWYAPC CCGs intend to commission in line with the guidance and align the Commissioning Statements.

The SWYAPC have also produced a letter to inform Community Pharmacies in Bradford, Calderdale, Kirklees and Wakefield of the local plans regarding the NHSE guidance.


Updates following the February Area Prescribing Committee Meeting

Red, Amber, Green Classifications:

Octreotide in syringe drivers – Agreement to classify as GSI for palliative care indications

Pentosan Polysulphate (Elmiron®) – Agreement to classify as RED for the indication Interstitial Cystitis (Unlicensed)


Updates following the December Area Prescribing Committee Meeting

Red, Amber, Green Classifications:

Venlafaxine doses above 300mg per day – re-classified from AMBER to GREEN for the treatment of major depressive episodes.For prevention of recurrence of major depressive episodes. Treatment of generalised anxiety disorder. Treatment of social anxiety disorder. Treatment of panic disorder, with or without agoraphobia.

(SPC no longer states doses above 300mg require specialist initiation and specific requirements for regular monitoring of blood pressure at doses above 300mg. Statement now reads. Blood pressure should be reviewed periodically, after initiation of treatment and after dose increases. I.e. no specific frequency and not specialist monitoring)

Dimethyl Fumarate (Skilarence) – for new indication of Psoriasis – classified as RED

•Azithromycin – for long term treatment of bronchiectasis & COPD – Classified as GREEN SPECIALIST INITIATION

•Metyrapone – for the management of patients with Cushings Syndrome – classified as RED for new patients and GREEN SPECIALIST INITIATION for existing patients.

Shared Care Guidelines

Alcohol drugs (acamprosate, disulfiram and naltrexone) – Approved