Lancashire and South Cumbria
Formulary
 
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10 Musculoskeletal and joint diseases

This chapter of the formulary is under continual development, please let the team know if you have any comments about the contents: mlcsu.lscformulary@nhs.net

For more information about the formulary development process, please see: https://www.lancsmmg.nhs.uk/lancashire-and-south-cumbria-icb-formulary-development/

10-01-03 Drugs affecting the immune response

Abatacept Orencia®
Formulary

Intravenous infusion 250mg
S/C injection 125mg prefilled syringe pre-filled pen 

Usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
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 TA715: Adalimumab, etanercept, infliximab and abatacept for treating moderate rheumatoid arthritis after conventional DMARDs have failed

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Adalimumab Biosimilars avaliable
Formulary

S/C injection 40mg prefilled syringe and pen

Usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

Link  MHRA: Tumour necrosis factor alpha inhibitors
Link  NICE TA195:Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
Link  NICE TA199: Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
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 TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
Link  NICE TA715: Adalimumab, etanercept, infliximab and abatacept for treating moderate rheumatoid arthritis after conventional DMARDs have failed

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Anakinra Kineret®
Formulary

Solution for injection pre-filled syringes  100mg/0.67mL

Link  NICE TA685: Anakinra for treating Stills disease

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Apremilast
Formulary

Tablets 10mg, 20mg, 30mg

Link  MHRA: Apremilast (Otezla ▼): risk of suicidal thoughts and behaviour
Link  NICE TA433: Apremilast for treating active psoriatic arthritis

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Azathioprine
Formulary

Tablets 25mg, 50mg

Link  LSCMMG: Shared care guideline - Azathioprine

Cytotoxic Drug  Amber 1 View adult BNF  View SPC online  View childrens BNF
Certolizumab Pegol Cimzia®
Formulary

S/C injection 200mg prefilled syringe pre-filled pen 

Usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

Link  MHRA: Tumour necrosis factor alpha inhibitors
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
Link  NICE TA445: Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs

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Ciclosporin
Formulary

Capsules 25mg, 50mg, 100mg

Link  LSCMMG: Shared care guideline - Ciclosporin

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Cyclophosphamide
Formulary
Tablets 50mg
Injection 200mg, 500mg, 1g

unlicensedunlicensed use

Cytotoxic Drug  Red View adult BNF  View SPC online  View childrens BNF
Etanercept Biosimilars avaliable
Formulary

S/C injection 25mg, 50mg vial with diluent and prefilled syringe pre-filled pen 

usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

Link  MHRA: Tumour necrosis factor alpha inhibitors
Link  NICE TA195:Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
Link  NICE TA199: Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
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 TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
Link  NICE TA715: Adalimumab, etanercept, infliximab and abatacept for treating moderate rheumatoid arthritis after conventional DMARDs have failed

Red View adult BNF  View SPC online  View childrens BNF  HCD
Golimumab Simponi®
Formulary

S/C injection 50mg, 100mg, prefilled syringe pre-filled pen 

Usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

Link  MHRA: Tumour necrosis factor alpha inhibitors
Link  NICE TA220: Golimumab for the treatment of psoriatic arthritis
Link  NICE TA225: Golimumab for the treatment of rheumatoid arthritis after the failure of previous disease-modifying anti-rheumatic drugs
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 TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
Link  NICE TA497: Golimumab for treating non-radiographic axial spondyloarthritis

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Guselkumab Tremfya®
Formulary

Solution for injection in pre-filled pen 100mg/1ml

Link  NICE TA815: Guselkumab for treating active psoriatic arthritis after inadequate response to DMARDs

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Infliximab Biosimilars avaliable
Formulary

Intravenous infusion 100mg, 120mg/ml pre-filled pen

REQUIRES BLUETEQ APPROVAL

Link  MHRA: Tumour necrosis factor alpha inhibitors
Link  NICE TA195:Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
Link  NICE TA199: Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis
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 TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
Link  NICE TA715: Adalimumab, etanercept, infliximab and abatacept for treating moderate rheumatoid arthritis after conventional DMARDs have failed

Red View adult BNF  View SPC online  View childrens BNF  HCD
Ixekizumab
Formulary

80mg solution for injection prefilled syringe; prefilled pen

Link  NICE TA537: Ixekizumab for treating active psoriatic arthritis after inadequate response to DMARDs
Link  NICE TA718: Ixekizumab for treating axial spondyloarthritis

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Leflunomide
Formulary

Tablets 10mg, 20mg

Link  LSCMMG: Shared care guideline - Leflunomide

Amber 2 View adult BNF  View SPC online  View childrens BNF
Methotrexate check local policy - branded generic available
Formulary

Tablets 2.5mg

S/C 5mg, 7.5mg, 10mg, 12.5mg, 15mg, 17.5mg, 20mg, 22.5mg, 25mg and 30mg


Methotrexate should be prescribed once weekly as a single dose on the same day each week.
If oral methotrexate is prescribed only use the 2.5 mg strength.

See hospital policy for prescribing and supply of oral methotrexate

Link  LSCMMG: Shared care guideline - Methotrexate

Cytotoxic Drug  Amber 2 View adult BNF  View SPC online  View childrens BNF
Risankizumab Skyrizi®
Formulary

solution for injection pre-filled syringes, solution for injection pre-filled pen 150mg/mL

Link  NICE TA803: Risankizumab for treating active psoriatic arthritis after inadequate response to DMARDs

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Rituximab (rheumatology) Biosimilars avaliable
Formulary

Concentrate for intravenous infusion 500mg/50mL


REQUIRES BLUETEQ APPROVAL

Link  NICE TA195:Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor

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Secukinumab
Formulary

150mg/ml pre-filled pens/syringes

Link  NICE TA407: Secukinumab for active ankylosing spondylitis after treatment with non-steroidal anti-inflammatory drugs or TNF-alpha inhibitors
Link  NICE TA445: Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs
Link  NICE TA719: Secukinumab for treating non-radiographic axial spondyloarthritis

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Tocilizumab Biosimilars avaliable
Formulary

Concentrate for intravenous infusion (20mg/mL) 80mg, 200mg, 400mg vials

Soution for injection in pre-filled syringe 162mg

Solution for injection in pre-filled pen 162mg


Usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

Link  MHRA: Tocilizumab (RoActemra): rare risk of serious liver injury including cases requiring transplantation
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
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 TA518: Tocilizumab for treating giant cell arteritis

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Ustekinumab
Formulary

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

Link  NICE TA340: Ustekinumab for treating active psoriatic arthritis

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