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Welcome to the March edition of Tablets, a prescribing newsletter produced monthly by the Medicines Management team at Midlands and Lancashire CSU.
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Recommendations
RED Arachis hypogaea L. (Palforzia®▼) for treating peanut allergy in children and young people
NICE recommends Palforzia as an option for treating peanut allergy in children aged 4 to 17. It can be continued in people who turn 18 while on treatment and should be used with a peanut-avoidant diet. fficacy data are currently available for up to 24 months of treatment. NICE does not specify treatment duration but estimates that 87% of children are expected to have discontinued treatment after 24 months based on trial data.
A short number of sentences extracted from the recommendation.
RED UPADACITINIB prolonged-release tablets (RINVOQ®▼) for psoriatic arthritis
NICE recommends upadacitinib, alone or with methotrexate, as an option for treating active psoriatic arthritis in adults whose disease has not responded well enough to DMARDs or who cannot tolerate them.
GREY FILGOTINIB tablets(Jyseleca®▼) for ulcerative colitis
Not recommended until NICE TA published.
GREY ICOSAPENT ETHYL capsules (Vazkepa®▼) for reducing the risk of cardiovascular events
Not recommended until NICE TA published.
GREY MEPOLIZUMAB injection (Nucala®) for chronic rhinosinusitis with nasal polyps
Not recommended until NICE TA published.
GREEN RIVAROXABAN 2.5mg tablets (Xarelto®▼) for the prevention of atherothrombotic events
Routine review of green statement at expiry, to be added to the static list. There is no new evidence to warrant a change in RAG status from green. No significant changes have been made, minor revisions include costs and updates in line with the SPC.
Formulary and Guidelines
RED Psoriasis in adults, sequential use of biologic agents
Addition of bimekizumab to guideline in line with recent NICE TA723, as Class 3: IL 17 agent.
GREEN Bevespi Aerosphere inhaler
Addition to the formulary for the treatment of COPD. Similar cost to the already agreed formulary alternatives and this is a metered dose inhaler that will be helpful for patients who need to use a spacer device.
GREEN Trixeo Aerosphere inhaler
Addition to the formulary for the treatment of COPD. This is the third triple therapy combination inhaler. Similar cost to the already agreed formulary alternatives and an alternative metered dose inhaler with a slightly lower carbon footprint than Trimbow.
GREEN Trimbow inhaler
The license for Trimbow has been extended to include asthma. This is the addition of the asthma indication to the formulary and it is the first triple therapy inhaler to be added to the formulary for this indication. It is a metred dose inhaler that will be helpful for patients who need to use a spacer device.
Safety
DEXAMETHASONE injection – different injection strengths
Routine review to STATIC at expiry date. Minor updates. Base dose equivalence table update to include 3.3 mg and 4 mg dose equivalence.
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Please click here or a full summary of safety updates and SPC updates in February
03 February 2022
Investigation was launched following errors in the prescription, dispensing and administration processes leading to a 4-year old child receiving 10 times the intended dose of anticoagulant on five separate occasions over three days, resulting in a non-fatal bleed on brain.
15 February 2022
MHRA advise clinicians to carefully consider benefits & risks before prescribing systemic azithromycin or other macrolides to patients on hydroxychloroquine or chloroquine. An observational study has shown co-administration is associated with increased cardiovascular mortality.
24 February 2022
Adult inpatients with low bodyweight (less than 50kg) and the risk of liver toxicity from oral paracetamol is the focus of this investigation, which speciifically focuses on the dose prescribed and the processes for ensuring weight is accurately recorded.
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NICE Guidance February 2022
There is one guideline published in February 2022 by the National Institute for Clinical Excellence which has impact upon primary care.
The Type 2 diabetes in adults: management guideline has been updated. This update reviewed the evidence on drug treatment and the new recommendation places SGLT2 inhibitors earlier in the drug treatment pathway for patients with atherosclerotic cardiovascular disease and heart failure. It is specifically recommended to offer an SGLT2 inhibitor with proven cardiovascular benefit in addition to metformin to such patients. It is also recommended to consider this intervention in patients at high risk of CVD characterised as a QRISK2 ≥ 10%. In patients who do not meet either of these criteria, SGLT2 inhibitors remains a second line treatment option along with DPP‑4 inhibitors, pioglitazone and sulfonylureas.
Clinicians should be aware of this guideline and implement any necessary changes to their practice.
CKS February 2022
During the month of February 2022, the following Clinical Knowledge Summaries were published or updated:
The Faecal incontinence in adults topic is new. All the remaining topics have been reviewed and updated in line with NICE guidance with minor layout changes. The Prostate cancer topic has been updated to include amended recommendations risk stratification and age-specific prostate-specific antigen (PSA) thresholds for referral. The Scrotal pain and swelling topic update reflect recommendations on assessment and management and a prescribing information section has been added that includes antibiotic treatment options for suspected acute epididymo-orchitis.
Clinicians can use the updated and new information when reviewing patients.
The information in the Prescribing News section has been adapted from the Prescribing Advice for GPs blog.
This section has been adapted from www.prescriber.org.uk
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