Lancashire and South Cumbria Formulary


	Lancashire and South Cumbria Formulary

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Formulary Chapter 13: Skin - Full Chapter

Notes:

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/

Details...

13.05.03

Drugs affecting the immune response

Abrocitinib

(Cibinqo ^®)

Formulary

Tablets 50mg - for treating moderate to severe atopic dermatitis

Tablets 100mg - for treating moderate to severe atopic dermatitis

Tablets 200mg - for treating moderate to severe atopic dermatitis

NICE TA814: Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis

Adalimumab (Biosimilars avaliable)

Formulary

S/C injection 40mg pre-filled syringe, pre-filled pen

Consultant dermatologist or specilaist initiation only

Tertiary centre only for hidradenitis suppurativa

Usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

MHRA: Tumour necrosis factor alpha inhibitors

NICE TA392: Adalimumab for treating moderate to severe hidradenitis suppurativa

NICE TA455: Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people

NIE TA146: Adalimumab for the treatment of adults with psoriasis

Apremilast (Otezla^®)

Formulary

Tablets 10mg, 20mg, 30mg

Usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

MHRA: Apremilast (Otezla ▼): risk of suicidal thoughts and behaviour

NICE TA419: Apremilast for treating moderate to severe plaque psoriasis

NICE TA433: Apremilast for treating active psoriatic arthritis

Azathioprine

Formulary

Tablets 25mg, 50mg
Unlicensed indication
Consultant dermatologist or specilaist initiation only
See section 10.1.3

LSCMMG: Shared care guideline - Azathioprine

Baricitinib

Formulary

Film-coated tablets 2mg, 4mg

Treatment of atopic dermatitis

Treatment of alopecia areata

NICE TA681: Baricitinib for treating moderate to severe atopic dermatitis

NICE TA926: Baricitinib for treating severe alopecia areata

Bimekizumab

(Bimzelx ^®)

Formulary

Pre-filled pen/syringe 160mg

Usually supplied to patients via a homecare delivery company

NICE TA723: Bimekizumab for treating moderate to severe plaque psoriasis

Brodalumab

(Kyntheum^®)

Formulary

Solution for injection pre-filled syringes 210mg/1.5ml

NICE TA511: Brodalumab for treating moderate to severe plaque psoriasis

Ciclosporin

Formulary

Consultant dermatologist or specilaist initiation only

To be prescribed generically for dermatology patients

See section 10.1.3

LSCMMG: Shared care guideline - Ciclosporin

Deucravacitinib (SOTYKTU )

Formulary

Film coated tablets 6mg

Red NICE TA907: Deucravacitinib for treating moderate to severe plaque psoriasis

NICE TA907: Deucravacitinib for treating moderate to severe plaque psoriasis

Dupilumab

(Dupixent^®)

Formulary

Pre-filled syringe 300mg/2ml solution for injection

NICE TA648: Dupilumab for treating chronic rhinosinusitis with nasal polyps (terminated appraisal)

NICE TA955: Dupilumab for treating moderate to severe prurigo nodularis

MHRA: Dupilumab (Dupixent▼): risk of ocular adverse reactions and need for prompt management

NICE TA534: Dupilumab for treating moderate to severe atopic dermatitis

NICE TA955: Dupilumab for treating moderate to severe prurigo nodularis

Etanercept (Biosimilars avaliable)

Formulary

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

Consultant dermatologist or specilaist initiation only
Usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

MHRA: Tumour necrosis factor alpha inhibitors

NICE TA103: Etanercept and efalizumab for the treatment of adults with psoriasis

NICE TA455: Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people

Guselkumab (Tremfya^®)

Formulary

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

NICE TA521: Guselkumab for treating moderate to severe plaque psoriasis

Infliximab (Biosimilars avaliable)

Formulary

Intravenous infusion 100mg

Consultant dermatologist or specilaist initiation only

REQUIRES BLUETEQ APPROVAL

MHRA: Tumour necrosis factor alpha inhibitors

NICE TA134: Infliximab for the treatment of adults with psoriasis

Lebrikizumab

Formulary

NHSE commissioned for children / young adults aged 12-18 years

NICE TA986: Lebrikizumab for treating moderate to severe atopic dermatitis in people 12 years and over

Methotrexate

Formulary

Consultant dermatologist or specialist initiation only

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

LSCMMG: Shared care guideline - Methotrexate

Pimecrolimus 1% (Elidel^®)

Formulary

Cream 30g, 60g, 100g

NICE TA82: Tacrolimus and pimecrolimus for atopic eczema

Risankizumab

(Skyrizi^®)

Formulary

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

Red BlueTeq NICE TA888 Risankizumab for previously treated moderately to severely active Crohn's disease - see link below

NICE TA596: Risankizumab for treating moderate to severe plaque psoriasis

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

Ritlecitinib

Formulary

Severe alopecia areata

BAD: Professional guidance supplementary to NICE TA958

NICE TA958: Ritlecitinib for treating severe alopecia areata in people 12 years and over

Secukinumab

(Cosentyx^®)

Formulary

150mg pre-filled syringe

Usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

Approved as Red Traffic Light for palmoplantar psoriasis - off-label use

NICE TA350: Secukinumab for treating moderate to severe plaque psoriasis

NICE TA445: Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs

NICE TA734: Secukinumab for treating moderate to severe plaque psoriasis in children and young people

Tacrolimus (Protopic^®)

Formulary

Ointment 0.03%, 0.1% 30g, 60g

Consultant dermatologist or specilaist initiation only

LSCMMG: Position Statement Prescribing of Oral Tacrolimus

MHRA: Tacrolimus ointment (Protopic): possible risk of malignancies including lymphomas and skin cancers

NICE TA82: Tacrolimus and pimecrolimus for atopic eczema

Tildrakizumab

(Ilumetri^®)

Formulary

Solution for injection pre-filled syringes 100mg/1ml

NICE TA575: Tildrakizumab for treating moderate to severe plaque psoriasis

Tralokinumab

(Adtralza ^®)

Formulary

Pre-filled syringe 150 mg solution for injection - for treating moderate to severe atopic dermatitis - see link below

NICE TA814: Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis

Upadacitinib

(Rinvoq ^®)

Formulary

Prolonged release tablets 15mg

MHRA: Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality

NICE TA814: Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis

NICE768: Upadacitinib for treating active psoriatic arthritis after inadequate response to DMARDs

Ustekinumab (Stelara^®)

Formulary

Injection 45mg, 90mg pre-filled syringe

Consultant dermatologist or specilaist initiation only
Usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

NICE TA180: Ustekinumab for the treatment of adults with moderate to severe psoriasis

NICE TA455: Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people

LSCMMG: Guidelines for the Management of Psoriasis in Primary Care

LSCMMG: Psoriasis in adults: LSCMMG Biologic and High Cost Drug Commissioning Pathway

NICE CG153: Psoriasis: assessment and management

....

Non Formulary Items

Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to children's BNF
	Link to SPCs
	Scottish Medicines Consortium

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG
	Low carbon footprint
	Medium carbon footprint
	High carbon footprint

Traffic Light Status Information

Status	Description
	Green: Appropriate for initiation and ongoing prescribing in both primary and secondary care. Generally, little or no routine drug monitoring is required.
	Green (Restricted): Appropriate for initiation and ongoing prescribing in both primary and secondary care provided: Additional criteria specific to the medicine or device are met, or The medicine or device is used following the failure of other therapies as defined by the relevant LSCMMG pathway. Generally, little or no routine drug monitoring is required.
	Red medicines: Medicine is supplied by the hospital for the duration of the treatment course. Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP. Red medicines are those where primary care prescribing is not recommended. These treatments should be initiated by specialists only and prescribing retained within secondary care. They require specialist knowledge, intensive monitoring, specific dose adjustments or further evaluation in use. If however, a primary care prescriber has particular specialist knowledge or experience of prescribing a particular drug for a particular patient it would not always be appropriate for them to expect to transfer that prescribing responsibility back to secondary care. There should be a specific reason and a specific risk agreement, protocol and service set up to support this. Primary care prescribers may prescribe RED medicines in exceptional circumstances to patients to ensure continuity of supply while arrangements are made to obtain ongoing supplies from secondary care.
	Amber level 0: Suitable for prescribing in primary care following recommendation or initiation by a specialist. Little or no specific monitoring required. Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care. Brief prescribing document or information sheet may be required. Primary care prescribers must be familiar with the drug to take on prescribing responsibility or must get the required information. When recommending or handing over care, specialists should ask primary care prescribers to take over prescribing responsibility, and should give enough information about the indication, dose, monitoring requirements, use outside product licence and any necessary dose adjustments to allow them to confidently prescribe.
	Amber level 1 (with shared care): Suitable for prescribing in primary care following recommendation or initiation by a specialist. Minimal monitoring required. Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care. Full prior agreement about patient’s on-going care must be reached under the shared care agreement. Primary care prescribers are advised not to take on prescribing of these medicines unless they have been adequately informed by letter of their responsibilities with regards monitoring, side effects and interactions and are happy to take on the prescribing responsibility. A copy of locally approved shared care guidelines should accompany this letter which outlines these responsibilities. Primary care prescribers should then tell secondary care of their intentions as soon as possible by letter so that arrangements can be made for the transfer of care.
	Amber level 2 (with shared care and enhanced service): Initiated by specialist and transferred to primary care following a successful initiation period. Significant monitoring required on an on-going basis. Full prior agreement about patient’s on-going care must be reached under the shared care agreement. Suitable for enhanced service. These medicines are considered suitable for GP prescribing following specialist initiation of therapy, as per shared care document which will be sent out with the request to prescribe, with on-going communication between the primary care prescriber and specialist. Amber Level 2 medicines require significant monitoring for which an enhanced service may be suitable. (Subject to local commissioning agreements).
	Do not prescribe: NOT recommended for use by the NHS in Lancashire and South Cumbria. Includes medicines that NICE has not recommended for use and terminated technology appraisals, unless there is a local need.
	Grey medicines: Medicines which have not yet been reviewed or are under the review process. GPs and specialists are recommended not to prescribe these drugs. This category includes drugs where funding has not yet been agreed.
	Refer to local guidance.