Medicines

Here you will find the recommendations we have made about the use of individual medicines in Lancashire.

Abatacept

Brand: Orencia®
NICE TA: 375
Indication: Rheumatoid arthritis, 1st line biologic (NICE TA375) and (LMMG RA Biologic Pathway)
Disease category: Musculoskeletal system
Commissioning responsibility: CCG
PbR excluded: Yes

Background

Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept, all in combination with methotrexate, are recommended as options for treating rheumatoid arthritis, only if:
• disease is severe, that is, a disease activity score (DAS28) greater than 5.1 and
• disease has not responded to intensive therapy with a combination of conventional disease-modifying antirheumatic drugs (DMARDs) and
• patient meets NICE criteria to start treatment
Rituximab in combination with methotrexate may be initiated in accordance with LMMG Flex 1 as follows:- Rituximab 1st Line: If patient has had cancer within the last 5 years, malignant melanoma at any point, moderate congestive heart failure, ILD.
Adalimumab, etanercept, certolizumab pegol or tocilizumab can be used as monotherapy for people who cannot take methotrexate because it is contraindicated or because of intolerance.
Treatment to be initiated with the most cost effective, clinically appropriate drug (taking into account administration costs, required dose and product price per dose). This may need to be varied in individual cases due to differences in the mode of administration and treatment schedules.

Decisions of Lancashire local decision making groups:

NHS Blackburn With Darwen CCG and NHS East Lancashire CCG NHS Blackpool CCG NHS Chorley and South Ribble CCG and NHS Greater Preston CCG NHS Fylde and Wyre CCG NHS Morecambe Bay CCG NHS West Lancashire CCG

Red

Red

Red

Red

Red

Red