Medicines

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

Denosumab

Brand: Prolia®
NICE TA: 
Indication: Denosumab for treatment of Glucocorticoid-induced osteoporosis
Disease category: Endocrine system
Commissioning responsibility: CCG
PbR excluded: No

Background

Patients with any of the following clinical features would be considered for treatment with denosumab:

• Upper gastrointestinal abnormalities, including oesophageal stricture, achalasia, abnormalities which delay oesophageal emptying, dysphagia, oesophageal disease (oesophagitis, ulcers, erosions), gastritis, duodenitis, gastric ulcers, previous upper GI surgery.
• Inability to sit or stand upright for at least 30 minutes.
• Renal impairment (eGFR 35ml/min). (Denosumab’s SPC states there is no data for patients with eGFR 30ml/min. Many clinicians are happy to use if eGFR > 20ml/min, provided serum calcium is closely monitored after each injection).
• Concerns about compliance with treatment – may include patients with cognitive impairment.

For patients with corticosteroid induced osteoporosis the LMMG has agreed that the choice of denosumab or zoledronic acid should be based on the clinical judgement of the responsible clinician.

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

Amber1

Amber1

Amber1

Amber1

Amber1

Amber1