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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

Baricitinib 2mg, 4mg (Olumiant®)
(Tablets)

RED
Restricted Drug Restricted

To be used in accordiance with nationally agreed criteria. See link to medicine request form which must be completed for each patient.

BNF BNFc SPC
Medicine Request Form (Bedford) - Baricitinib Medicine Request Form (Luton) - Baricitinib MHRA DSU April 2023 - Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality

Baricitinib 2mg, 4mg (Olumiant®)
(Tablets)

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 TA466.
BNF BNFc SPC
MHRA Drug Safety Update: Baricitinib (Olumiant¥): increased risk of diverticulitis, particularly in patients with risk factors (August 2020) MHRA Drug Safety Update: Baricitinib (Olumiant¥): risk of venous thromboembolism (March 2020) MHRA DSU April 2023 - Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality NICE TA466: Baricitinib for moderate to severe rheumatoid arthritis NICE TA982: Baricitinib for treating juvenile idiopathic arthritis in people 2 years and over (TERMINATED APPRAISAL)

Filgotinib (Jyseleca®)
(100mg and 200mg film-coated tablets)

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 the following NICE TA(s):-

BNF BNFc SPC
MHRA DSU April 2023 - Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality TA676 Filgotinib for treating moderate to severe rheumatoid arthritis

Guselkumab (Tremfya®)
(100 mg solution for injection in pre-filled pen)

RED
Restricted Drug Restricted

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

 For use in accordance with the following NICE TA(s):

BNF BNFc SPC BlueTeq
NICE TA711: Guselkumab for treating active psoriatic arthritis after inadequate response to DMARDs NICE TA815: Guselkumab for treating active psoriatic arthritis after inadequate response to DMARDs

Ixekizumab (Taltz®)
(80 mg solution for injection in pre-filled syringe or pre-filled pen)

RED
Restricted Drug Restricted

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

For use in accordance with the following NICE TAs:

 

BNF BNFc SPC BlueTeq
Interim Clinical Commissioning Policy Medicine Request Form - Baricitinib

Tofacitinib (Xeljanz®)
(Tablets)

RED
Restricted Drug Restricted

FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.
Approved in accordance with the NICE TA's below.

BNF BNFc SPC
MHRA DSU March 2020: Tofacitinib (Xeljanz): new measures to minimise risk of venous thromboembolism and of serious and fatal infections MHRA DSU Oct 2021: Tofacitinib new measures to minimise risk of major adverse cardiovascular events and malignancies MHRA DSU April 2023 - Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality NICE TA480: Tofacitinib for moderate to severe rheumatoid arthritis NICE TA543: Tofacitinib for treating active psoriatic arthritis after inadequate response to DMARDs NICE TA735 Tofacitinib for treating juvenile idiopathic arthritis NICE TA920: Tofacitinib for treating active ankylosing spondylitis

Upadacitinib (RINVOQ®)
(15 mg Polonged-release tablets)

RED
Restricted Drug Restricted

FOR ALL PRESCRIBING - Blueteq or High cost drug form requested - see link from Formulary Homepage.

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

BNF BNFc SPC BlueTeq
MHRA DSU April 2023 - Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality NICE TA665: Upadacitinib for treating severe rheumatoid arthritis NICE TA744: Upadacitinib for treating moderate rheumatoid arthritis NICE TA768: Upadacitinib for treating active psoriatic arthritis after inadequate response to DMARDs NICE TA829: Upadacitinib for treating active ankylosing spondylitis NICE TA861: Upadacitinib for treating active non-radiographic axial spondyloarthritis
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
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.