The Pan Mersey Area Prescribing Committee recommends the use of adalimumab, certolizumab pegol, etanercept, golimumab, infliximab and secukinumab▼ in the management of ankylosing spondylitis (AS), and adalimumab, certolizumab pegol, golimumab and etanercept in non-radiographic axial spondyloarthritis (NRAxSpA) in accordance with NICE TA383, NICE TA407 and NICE TA497.
This Guidance does not include prescribing advice to primary care from secondary care specialists e.g. oral medicine, special care dentistry or oral and maxillofacial surgery, regarding the management of complex conditions and patients with multiple co-morbidities.
The Pan Mersey Area Prescribing Committee recommends the prescribing of biologic agents, by specialists only, for Juvenile Idiopathic Arthritis (JIA) as per NICE TA373 and TA238 in adult and paediatric services.
The Pan Mersey Area Prescribing Committee recommends the prescribing of anti-TNF (adalimumab, certolizumab, etanercept, golimumab, infliximab) by specialists only, for inflammatory monoarthritis or oligoarthritis as specified.
If a private consultation identifies a long-term condition or a need for medication which is available as routine NHS treatment, this should be provided as such by the patient's usual primary care prescriber if they are satisfied it is appropriate, and the private provider issues the first prescription.
The Pan Mersey Area Prescribing Committee recommends the sequential use of biological agents, adalimumab (Humira®), brodalumab (Kyntheum®▼), etanercept (Benepali®▼, Enbrel®), guselkumab (Tremfya®▼), infliximab (Inflectra®▼, Remicade®, Remsima®▼), ixekizumab (Taltz®▼), secukinumab (Cosentyx®▼) and ustekinumab (Stelara®), in the management of psoriasis according to the attached flowchart.
The Pan Mersey Area Prescribing Committee recommends the sequential use of high cost agents, adalimumab, apremilast▼, certolizumab, etanercept, golimumab, infliximab, ixekizumab▼, secukinumab▼, tofacitinib▼ and ustekinumab in the management of psoriatic arthritis (PsA) in accordance with the recommendations below, and the accompanying flowchart.
The Pan Mersey Area Prescribing Committee recommends that psychotropic drugs in people with a learning disability, autism or both should be reviewed and reduced in primary care in line with NHS England (NHSE) guidelines. Psychotropics should be initiated by a learning disability specialist.
Pan Mersey Area Prescribing Committee recommends that prescribers should NOT supply treatment durations in excess of THREE MONTHS for patients who are going to live or travelling abroad or otherwise absent from the UK. Patients should make local arrangements in their country of residence for on-going medical care.
This document is a good practice guide to support prescribers with prescribing unlicensed and “off-label” medicines. It describes the differences between licensed medicines, unlicensed medicines and “off-label” medicines. It advises prescribers on a stepped approach when considering what to prescribe, and highlights the prescriber’s responsibilities and best practice around patient communication.
RED - Drugs which should be prescribed only by a specialist clinician.
AMBER - These medicines are considered suitable for primary care prescribing following varied levels of specialist input as described below:
Amber medicines are considered suitable for primary care prescribing following varied levels of specialist input as described below: AMBER Recommended - Requires specialist assessment and recommendation to a GP to prescribe in primary care. AMBER Initiated - Requires specialist initiation of prescribing. Prescribing is to be continued by the specialist until stabilisation of the dose is achieved and the patient has been reviewed by the specialist. AMBER Retained - Requires specialist initiation of prescribing. Prescribing to be continued by the specialist until stabilisation of the dose is achieved and the patient had been reviewed by the specialist. The patient remains under the care of specialist (i.e. not discharged) as occasional specialist input may be required.
PURPLE - Follows specialist initiation of therapy, with on-going communication between the Primary Care prescriber and specialist, within the framework of a Shared Care Agreement.
BLACK - Not recommended for use because of a lack of evidence of clinical effectiveness, cost prioritisation or concerns over safety.
GREY - Still being evaluated according to local processes and a decision on whether to commission their use has not yet been made. They should not be prescribed in any setting.
GREEN - GPs would normally take full responsibility for prescribing and monitoring. Green status does not imply that a medicine is superior to existing first-line drugs or is a recommended formulary choice.