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Bedfordshire and Luton Joint Formulary
Bedfordshire Hospitals NHS Foundation Trust
Bedfordshire, Luton and Milton Keynes ICB
Formulary Chapter: 10 - Musculoskeletal and joint diseases 
Notes:

Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing
10.01.03 Drugs which suppress the rheumatic disease process
BLMK APC Biologics Treatment pathway for Ankylosing Spondylitis and Non-radiographic Axial Spondyloarthritis (nrAxial SpA) BLMK APC Treatment Pathway for Active Psoriatic Arthritis (non-Axial PsA) after inadequate response to DMARDs BLMK APC Treatment pathway for Moderate Rheumatoid Arthritis BLMK APC Treatment Pathway for Severe Rheumatoid Arthritis JPC Biologics Treatment Pathway for ankylosing spondylitis and Non-radiographic Axial Spondyloarthritis (March 2018) NICE TA199: Psoriatic arthritis - etanercept, infliximab and adalimumab (NICE TA199) NICE TA375:Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis Rheumatology Overarching shared care guideline
10.01.03 Gold
10.01.03 Penicillamine
10.01.03 Antimalarials
10.01.03 Drugs affecting the immune response
10.01.03 Cytokine modulators
BLMK APC Biologics Treatment pathway for Ankylosing Spondylitis and Non-radiographic Axial Spondyloarthritis (nrAxial SpA) BLMK APC Treatment Pathway for Active Psoriatic Arthritis (non-Axial PsA) after inadequate response to DMARDs BLMK APC Treatment pathway for Moderate Rheumatoid Arthritis BLMK APC Treatment Pathway for Severe Rheumatoid Arthritis JPC Biologics Treatment Pathway for ankylosing spondylitis and Non-radiographic Axial Spondyloarthritis (March 2018) NICE TA199: Psoriatic arthritis - etanercept, infliximab and adalimumab (NICE TA199) NICE TA375:Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis Rheumatology Overarching shared care guideline

Abatacept (Orencia®)

RED
Restricted Drug Restricted

FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.

125mg Pre-filled Syringe OR pen for sub-cutaneous injection.
250mg injection for IV infusion.

Must be prescribed by a Rheumatology consultant in accordance with NICE TA373 & TA375 for the treatment of rheumatoid and juvenile arthritis.

Shortage of Orencia - NPSA Alert

BNF BNFc SPC
NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis 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

Adalimumab (Amgevita®)
(Rheumatology)

RED
Restricted Drug Restricted

Choice:

Amgevita (biosimilar brand) preferred brand for new patients.

Imraldi & Idacio for existing patients only

Humira for existing patients only (originator brand)

 

FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.

Must only be prescribed by Rheumatology Consultant in accordance with the following NICE TAs:

BNF BNFc SPC BlueTeq
NICE TA 715 Adalimumab, etanercept, infliximab and abatacept for treating moderate rheumatoid arthritis after conventional DMARDs have failed NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor 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

Bimekizumab (Bimzelx®)
(160 mg solution for injection in pre-filled pen or pre-filled syringe)

RED
Restricted Drug Restricted

RESTRICTED FOR ALL PRESCRIBING - Blueteq or high cost drug form required - see link from Formulary homepage,

 

To be used in accordance with the following NICE TA(s) only:

BNF BNFc SPC BlueTeq
NICE TA916: Bimekizumab for treating active psoriatic arthritis NICE TA918: Bimekizumab for treating axial spondyloarthritis

Certolizumab Pegol 200mg (Cimzia®)
(Injection , pre-filled pen or syringe)

RED
Restricted Drug Restricted
FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.

Must be prescribed by a Rheumatology consultant in accordance with NICE TA375, TA383 or TA445.



BNF BNFc SPC
MHRA Drug Safety Update (April 2014) - Tumour necrosis factor alpha inhibitors 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 NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis NICE TA445: Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs

Etanercept (Benepali®)

RED
Restricted Drug Restricted

 

Preferred brand: Benepali

Enbrel (originator brand) for existing patients only

ALL prescribing of etanercept must be by brand name. 

 

FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.


 
See section 13.05.03 (for Dermatology)

 

Must be prescribed by Consultant Rheumatologist in accordance with the following NICE TA(s):

BNF BNFc SPC BlueTeq
NICE TA 715 Adalimumab, etanercept, infliximab and abatacept for treating moderate rheumatoid arthritis after conventional DMARDs have failed NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor NICE TA199: Psoriatic arthritis - etanercept, infliximab and adalimumab NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis 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

Golimumab 50mg, 100mg (Simponi®)
(Injection, pre-filled pen or syringe)

RED
Restricted Drug Restricted

FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.

Must be prescribed by a Consultant Rheumatologist in accordance with NICE TA's below.

BNF BNFc SPC
MHRA Drug Safety Update (April 2014) - Tumour necrosis factor alpha inhibitors NICE TA220: Psoriatic arthritis - golimumab NICE TA225: Rheumatoid arthritis - golimumab NICE TA233: Ankylosing spondylitis - golimumab NICE TA497: Golimumab for treating non-radiographic axial spondyloarthritis

Infliximab (Remsima®)

RED
Restricted Drug Restricted

FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.

 Remicade (originator brand) for existing patients only

NOTE:
ALL prescribing of infliximab must be by brand name. 

Must be prescribed by a Rheumatology Consultant in accordance with the below NICE TA(s):


 
 

BNF BNFc SPC BlueTeq
NICE TA 715 Adalimumab, etanercept, infliximab and abatacept for treating moderate rheumatoid arthritis after conventional DMARDs have failed NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor NICE TA199: Psoriatic arthritis - etanercept, infliximab and adalimumab 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 NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis

Risankizumab (Skyrizi®)
(150mg solution for injection in pre-filled syringe or pen)

RED
Restricted Drug Restricted

FOR ALL PRESCRIBING - Blueteq or High Cost Drug Form required - see link from Formulary Homepage.

Restricted to Specialist Prescribing in accordance with the following NICE TA(s):

BNF BNFc SPC BlueTeq
NICE TA803: Risankizumab for treating active psoriatic arthritis after inadequate response to DMARDs

Rituximab (Truxima®)

RED
Restricted Drug Restricted

FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.

Preferred brand: Truxima

Mabthera (originator brand) for existing patients only

Must be prescribed by Rheumatology Consultant in accordance with the below NICE TA(s):

BNF BNFc SPC BlueTeq
NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor NICE TA308: Rituximab in combination with glucocorticoids for treating anti-neutrophil cytoplasmic antibody-associated vasculitis

Sarilumab 200mg
(Pre-filled pen or syringe)

RED
Restricted Drug Restricted

For off-label use in COVID-19 patients according to nationally agreed criteria.

See link to medicine request form which must be completed for each patient. (to be added).

BNF BNFc SPC
Medicines Request Form (Bedford) - Sarilumab Medicines Request Form (Luton)- Sarilumab Prescription and Administration Form

Sarilumab 150mg, 200mg
(Pre-filled pen or syringe)

RED
Restricted Drug Restricted

FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.
Approved in accordance with: NICE TA485 for moderate to severe rheumatoid arthritis.

BNF BNFc SPC
NICE TA485:Sarilumab for moderate to severe rheumatoid arthritis NICE TA1104: Sarilumab for treating polyarticular or oligoarticular juvenile idiopathic arthritis in people 2 to 17 years (TERMINATED APPRAISAL)

Secukinumab 150mg (Cosentyx®)
(Pre-filled pen or syringe)

RED
Restricted Drug Restricted

FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.

Restricted to prescribing by Consultant Rheumatologist in accordance with the following NICE TA(s):

BNF BNFc SPC
NICE TA 719 Secukinumab for treating non-radiographic axial spondyloarthritis, Technology appraisal guidance NICE TA407: Secukinumab for active ankylosing spondylitis after treatment with NSAIDs or TNF-alpha inhibitors

Tocilizumab (Tyenne®)

RED
Restricted Drug Restricted

FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.

162mg pre-filled syringe for subcutaneous injection
80mg, 200mg, 400mg solution for intravenous infusion

Must be prescribed by a Rheumatology consultant in accordance with the NICE TA's below.

Preferred brand: Tyenne®

Originator brand: RoActemra® (for existing patients only)

 

Entry reviewed: July 2024

BNF BNFc SPC
NICE TA238: Arthritis (juvenile idiopathic, systemic) - tocilizumab NICE TA247: Rheumatoid arthritis - tocilizumab (rapid review TA198) NICE TA518: Tocilizumab for treating giant cell arteritis

Ustekinumab 45mg, 90mg (Pyzchiva® Wezenla®)
(Pre-filled syringe)

RED
Restricted Drug Restricted

Pyzchiva® or Wezenla® (biosimilar brands) preferred for new patients.

Stelara® for existing patients only (originator brand)

FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.

Restricted to prescribing by Consultant Rheumatologist for the treatment of active psoriatic arthritis in accordance with NICE TA340.

Entry reviewed: October 2024

BNF BNFc SPC
MHRA Drug Safety Update (Jan 15): (Stelara®) - risk of exfoliative dermatitis NICE TA340 - treating active psoriatic arthritis
10.01.03 Sulfasalazine
Classifications
GREEN
May be initiated in any care setting
Amber SPA
Specialist to advise therapy and provide first 28 days supply, continuation in Primary Care
Amber SPIS
Specialist to initiate and stabilise medicine prior to continuation in Primary Care
SCG
To be prescribed as per Shared Care Guidance. If no SCG in place status reverts to red.
RED
Red medicines are designated as specialist only medicines which should only be prescribed by a specialist, usually within secondary care (either due to the requirement for specialist knowledge, long-term monitoring requirements, or restrictions that mean medicine supplies are only available to hospitals).
DNP
A decision has been made either locally and/or nationally not to routinely commission this preparation. Do not prescribe.
SELF
To be purchased over the counter. May be prescribed for chronic, long term conditions or on admission to hospital if essential.