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BLMK Area Prescribing Committee (APC)

Newsletter October 2021, Number 01

Summary of Key Recommendations - 29th September 2021 APC Meeting

(For full details of Joint Formulary additions / amendments - see seperate Formulary Newsletter - Click Here

Joint Formulary Image

The following organisations contribute to and participate in the BLMK APC – Bedfordshire, Luton and Milton Keynes Clinical Commissioning Group; Bedfordshire Hospitals NHS Foundation Trust; Cambridgeshire Community Services NHS Trust; Central and North West London NHS Foundation Trust; East London NHS Foundation Trust; Milton Keynes University Hospital NHS Foundation Trust.

Welcome to the first BLMK Area Prescribing Committee (APC) newsletter.

As a result of the CCG merger, the previous Bedfordshire and Luton Joint Prescribing Committee (JPC) and Milton Keynes Prescribing Advisory Committee (MKPAG) have been replaced with a BLMK wide Area Prescribing Committee (BLMK APC).  The contents of this newsletter reflect the output from the first APC meeting.

BLMK Medicines Management Team Website Update:-

Following the CCG merger, from Sept 2021, all approved APC Documents will be uploaded to this website. All current approved JPC/MKPAG documents will also remain on the website as before.

Medicines Management Team Website:- https://medicines.blmkccg.nhs.uk/

Searching the website:-
All documents referred to within the Newsletter (where appropriate) will be available shortly on the website.

The website has an easy to use search function which should make it easy to find the information you are looking for. If you have trouble searching the website or if you have any comments / suggestions, please do let us know - contact either Samantha.scholes@nhs.net (Website Manager) or Sandra.McGroarty@nhs.net (Website Pharmacist Clinical Lead)

TREATMENT / PRESCRIBING GUIDELINES

Primary Care Guidelines for Adults with Asthma Update

This guideline has been reviewed as part of the BLMK Integrated Care System (ICS) policy alignment within primary care and was approved by the APC.

In addition to the full guideline, a short reference guide will be produced to assist prescribers and this will be available shortly.

 

SECONDARY CARE PRESCRIBING / COMMISSIONING ISSUES

Treatment Pathway for Active Psoriatic Arthritis

This pathway has been updated to include Guselkumab as a treatment option in accordance with NICE TA 711, published 30 June 2021 – Guselkumab for treating active psoriatic arthritis after inadequate response to DMARDs.The updated pathway has been agreed (and applies) across BLMK ICS.

Ankylosing Spondylitis – Biologics Treatment pathway for Ankylosing Spondylitis and Non-radiographic Axial Spondyloarthritis (nrAxial SpA)

The biologics treatment pathway for Ankylosing Spondylitis and Non-radiographic Axial Spondyloarthritis (nrAxial SpA) has been updated following publication of two new NICE technology appraisal guidance:-

  • Ixekizumab for treating axial spondyloarthritis (TA718, Published: 21 July 2021)
  • Secukinumab for treating non-radiographic axial spondyloarthritis (TA719, Published: 21 July 2021)

The updated pathway has been agreed (and applies), across BLMK ICS.

Treatment Pathway for Rheumatoid Arthritis Update

Algorithm A – Treatment of Moderate to Severe Rheumatoid Arthritis (after inadequate response to DMARDs) has been updated in response to the publication of NICE TA 715, published 14 July 2021 – Adalimumab, etanercept, infliximab and abatacept for treating moderate rheumatoid arthritis after conventional DMARDs have failed.
The updated pathway has been agreed (and applies), across BLMK ICS.

Severe Psoriasis Pathway

The Severe Psoriasis pathway has been updated following publication of a new NICE technology appraisal guidance (Bimekizumab for treating moderate to severe plaque psoriasis, TA723, Published: 01 September 2021).
The updated pathway has been agreed (and applies), across BLMK ICS.

SHARED CARE GUIDELINES

The following shared care guidelines were approved by the APC:

Cinacalcet for the treatment of primary Hyperparathyroidism in patients with severe hypercalcaemia awaiting surgery or deemed unfit for surgical management.
Denosumab (Prolia®) For The Treatment Of Osteoporosis In Post-Menopausal Women And Adult Males (≥ 50 years) At Increased Risk Of Fractures.
Transgender Shared Care Guidelines.

 

 

FORMULARY - IMPORTANT

Click here to access the Medicines and Wound Care Formularies Update

The following addition to the Joint Formularies has been mandated by NHS England:-

  • Inclisiran for treating primary hypercholesterolaemia or mixed dyslipidaemia which is recommended as per NICE TA 733 and may be initiated by prescribers in Primary Care (Green status on both the Bedfordshire and Luton Joint Formulary and the Milton Keynes Joint Formularies)
NICE TECHNOLOGY APPRASIAL GUIDANCE and GUIDELINES ISSUES / UPDATED

The following NICE Technology Appraisal Guidance (CCG Commissioned) have been published during the period 17th June – 15th September 2021 inclusive :-

Budesonide orodispersible tablet for inducing remission of eosinophilic oesophagitis
Technology appraisal guidance [TA708] Published: 23 June 2021  https://www.nice.org.uk/guidance/ta708

 

Hospital only (red) designation on both Bedfordshire/Luton and Milton Keynes Joint Formularies

Guselkumab for treating active psoriatic arthritis after inadequate response to DMARDs
Technology appraisal guidance [TA711] Published: 30 June 2021 https://www.nice.org.uk/guidance/ta711

 

Pathway updated – see above under SECONDARY CARE PRESCRIBING / COMMISSIONING ISSUES

Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation
Technology appraisal guidance [TA249]Published: 15 March 2012 Last updated: 02 July 2021. https://www.nice.org.uk/guidance/ta249

Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation
Technology appraisal guidance [TA256]Published: 23 May 2012 Last updated: 02 July 2021. https://www.nice.org.uk/guidance/ta256

Apixaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation
Technology appraisal guidance [TA275]Published: 27 February 2013 Last updated: 02 July 2021. https://www.nice.org.uk/guidance/ta275

Edoxaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation
Technology appraisal guidance [TA355]Published: 23 September 2015 Last updated: 02 July 2021. https://www.nice.org.uk/guidance/ta355

In July 2021, NICE updated recommendation 1.2 in all four NICE TAs (outlined above) to include the other anticoagulants approved by NICE.

Please see the NICE guideline on atrial fibrillation for further guidance on using this treatment.

Adalimumab, etanercept, infliximab and abatacept for treating moderate rheumatoid arthritis after conventional DMARDs have failed
Technology appraisal guidance [TA715]Published: 14 July 2021. https://www.nice.org.uk/guidance/ta715

Pathway updated – see above under SECONDARY CARE PRESCRIBING / COMMISSIONING ISSUES

Secukinumab for treating non-radiographic axial spondyloarthritis
Technology appraisal guidance [TA719]Published: 21 July 2021. https://www.nice.org.uk/guidance/ta719

Ixekizumab for treating axial spondyloarthritis
Technology appraisal guidance [TA718]Published: 21 July 2021. https://www.nice.org.uk/guidance/ta718

Pathway updated – see above under SECONDARY CARE PRESCRIBING / COMMISSIONING ISSUES

Continuous positive airway pressure for the treatment of obstructive sleep apnoea/hypopnoea syndrome
Technology appraisal guidance [TA139]Published: 26 March 2008 Last updated: 20 August 2021. https://www.nice.org.uk/guidance/ta139

Bimekizumab for treating moderate to severe plaque psoriasis
Technology appraisal guidance [TA723]Published: 01 September 2021 https://www.nice.org.uk/guidance/ta723

Pathway updated – see above under SECONDARY CARE PRESCRIBING / COMMISSIONING ISSUES

NICE Guidelines :-

NICE have published several NICE Guidelines since June 2021 and these are all available on the main NICE website

NICE COVID-19 Rapid Reviews/Information

The Committee noted that NICE have continued to issue/update a series of covid 19 rapid reviews/information:– this information can be accessed from the NICE website  click here

MEDICINES SAFETY DRUG UPDATES (DSU) AND PATIENT SAFETY ALERTS

The BLMK Integrated Care System (ICS) Medicines Safety Group has been set up to provide a system wide, cross-sector medicines safety network, encouraging shared learning amongst care providers and commissioners, optimising pathways and systems to further improve patient centred, medicines safety outcomes in line with national and local programmes. The appointed co-chairs for this year are the medication safety officers from MKUH and BHFT (Luton Site).

 

Please see below for the MHRA drug safety updates for July, August and September 2021:
MHRA DSU July 2021 – includes choramphenicol use in under 2s, yellow card reporting for homeopathic medicines, oral retinoid monitoring advice during pandemic
MHRA DSU August 2021 – includes update on COVID-19 vaccine information
MHRA DSU September 2021 – includes DSU on topical corticosteroids

 

National patient safety alerts to note from July to September 2021:
Inappropriate anticoagulation of patients with a mechanical heart valve – NPSA Alert – 14th July 2021

For more information on which patient cohorts are not suitable for switching (and should remain on VKA) during the pandemic, please refer to https://www.nice.org.uk/Media/Default/About/COVID-19/Specialty-guides/specialty-guide-anticoagulant-services-and-coronavirus.pdf

 

Potent synthetic opioids implicated in increase in drug overdoses – NPSA Alert – 18th August 2021
Public health have also issued a statement here:  https://www.gov.uk/government/news/drug-users-urged-to-be-extra-careful-following-a-high-number-of-likely-heroin-overdoses

 

Supply disruption alerts to note from July to September 2021:
Becton Dickinson blood specimen collection – supply disruption

 

ANTIMICROBIAL RESISTANCE UPDATE

The following information was brought to the committee for noting:

  • Letter from NHSE- NHS System Oversight Framework (SOF) Antimicrobial Prescribing Metrics for 2021-22. This advises that the following metrics in relation to antimicrobial prescribing will be introduced for 21/22:
SOF Indicator AMR Metric Description
44a The number of antibiotic (antibacterial) items prescribed in primary care, divided by the item-based Specific Therapeutic group Age-Sex related Prescribing Unit STAR-PU per annum At or less than 0.871
44b The number of broad-spectrum antibiotic (antibacterial) items from co-amoxiclav, cephalosporin class and fluoroquinolone class drugs as a percentage of the total number of antibacterial items prescribed in primary care. At or less than 10%
EAST OF ENGLAND PRIORITIES ADVISORY COMMITTEE (EoEPAC)

The APC ratified the EoEPAC bulletin and following recommendations relating to the Thuasne ActionReliever® Off-loading Knee Brace for Knee Osteoarthritis:-

  • Not recommended for prescribing in primary care.
    • Routine use of Thuasne ActionReliever® off-loading knee brace is not recommended.
    • It may have a limited place in therapy for some patients including those where surgery is contra-indicated. However, fitting and support from a trained orthotist or physiotherapist or other specialist healthcare professional is essential to ensure maximum benefit is achieved.
    • If after specialist consultation, Thuasne ActionReliever® off-loading knee brace is considered to be the best option for the patient, it should be supplied by a Specialist or secondary care clinic as part of the activity costs.
ADDITIONAL PAPERS / ISSUES CONSIDERED BY THE COMMITTEE

The APC noted for information, the National Overprescribing Review Report – Click here to access it.

BLMK APC MEETING DATES - 2021/22

Wednesday 1st December 2021
Wednesday 2nd March 2022
Wednesday 4th May 2022
Wednesday 29th June 2022
Wednesday 28th September 2022
Wednesday 7th December 2022

OTHER NEWS
Use of Scriptswitch/Optimise Rx
To further enhance the communication of BLMK APC advice to GPs, the BLMK CCG medicine management team are actively reviewing the messages on NetFormulary, Scriptswitch and Optimise Rx to highlight when BLMK APC guidance is available and including a hyperlink to the BLMK Medicines Management website.
 

Contact Us:-    jacqueline.clayton@nhs.net and sandra.mcgroarty@nhs.net

 

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