North Central London
Joint Formulary
 
back
10 Musculoskeletal and joint diseases
10-01-03 Cytokine modulators

Abatacept
Restricted

Approved for:

  • Rheumatoid arthritis in line with the NCL RA pathway
  • Juvenile Idiopathic Arthritis (JIA; see NICE TAs)

Provider notes

  • NMUH:
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • To be prescribed by Rheumatologists ONLY.
    • Check MHRA Drug Safety Updates.
    • See links below.
  • RFL:
    • Approved for Rheumatoid Arthritis and Juvenile Idiopathic Arthritis, in line with NICE guidance
  • RNOH:
    • Restricted to Rheumatology Consultants ONLY.
  • UCLH:
  • WH:
    • As per NICE TA and above
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NICE TA195: Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
 

Restricted Drug GP - Red View adult BNF  View SPC online  View childrens BNF  HCD
Adalimumab
Restricted

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for:

  • Rheumatoid arthritis in line with the NCL RA pathway
  • Juvenile Idiopathic Arthritis (JIA; see NICE TA)
  • Ankylosing Spondylitis (see NICE TAs)
  • Psoriatic Arthritis (PsA; see NICE TAs)

Provider notes

  • NMUH: 
    • Check MHRA Drug Safety Updates
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • Restricted to Consultant Rheumatologists
    • See links below
  • RFL:
    • Approved for use in Psoriatic Arthritis, Rheumatoid Arthritis, Ankylosing Spondylitis and non-radiographic axial spondyloarthritis
  • RNOH:
    • Restricted to Rheumatology Consultants Only
  • UCLH:
  • WH:
    • As per NICE TA and above
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NICE TA195: Rheumatoid arthritis - after failure of a TNF inhibitor
Link  NICE TA199: Psoriatic arthritis
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
 

Restricted Drug GP - Red View adult BNF  View SPC online  View childrens BNF  HCD
Anakinra
Restricted

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for adult-onset Stills disease in line with NHSE commissioning policy (JFC October 2018)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Approved for AOSD in line with NHSE policy (see below)
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
Link  NHSE 170056P: Anakinra/tocilizumab for the treatment of Adult-Onset Stillís Disease refractory to second-line therapy (adults)
 

Restricted Drug GP - Red View adult BNF  View SPC online  View childrens BNF
Apremilast
Restricted

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for:

  • Psoriatic Arthritis (PsA; see NICE TA)

Provider notes

  • NMUH:
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • To be prescribed by Rheumatologists ONLY
    • See links below
    • Check MHRA Drug Safety Updates
  • RFL:
    • As per NICE guidance for PsA
  • RNOH:
    • Rheumatology Consultants ONLY
  • UCLH:
  • WH:
    • As per NICE TA and above
Link  NICE TA433: Apremilast for treating active psoriatic arthritis
 

Restricted Drug GP - Red View adult BNF  View SPC online  View childrens BNF  HCD
Baricitinib
Restricted

Approved for:

  • Rheumatoid arthritis (see NICE TA)

Provider notes

  • NMUH:
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines - TO AWAIT UPDATED NCL JFC PATHWAY PRIOR TO PRESCRIBING
    • See link below
  • RFL:
    • As per NICE guidance for the treatment of RA
  • RNOH:
    • Rheumatology Consultants Only
  • UCLH:
  • WH:
    • As per NICE TA and above
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NICE TA466: Baricitinib for moderate to severe rheumatoid arthritis
 

Restricted Drug View adult BNF  View SPC online  View childrens BNF
Certolizumab pegol
Restricted

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for:

  • Rheumatoid arthritis in line with the NCL RA pathway
  • Ankylosing Spondylitis (see NICE TAs)
  • Psoriatic arthritis (PsA; see NICE TAs)

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines (see links below).
    • Restricted to Consultant Rheumatologists
    • See MHRA Drug Safety Update.
    • See links below.
  • RFL:
    • Approved for Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis and non-radiographic axial spondyloarthritis in line with NICE guidance.
  • RNOH:
    • Restricted for Rheumatology Consultants ONLY.
    • See links below.
  • UCLH:
  • WH:
    • As per NICE TA and above
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
Link  NICE TA415: Certolizumab pegol for treating rheumatoid arthritis after inadequate response to a TNF-alpha inhibitor
Link  NICE TA445 : Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARD
 

Restricted Drug GP - Red View adult BNF  View SPC online  View childrens BNF  HCD
Etanercept
Restricted

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

JFC approved Benepali as the brand of choice.

Approved for:

  • Rheumatoid arthritis in line with the NCL RA pathway
  • Juvenile Idiopathic Arthritis (JIA; see NICE TAs below)
  • Ankylosing spondylitis (see NICE TAs below)
  • Psoriatic Arthritis (PsA; see NICE TAs below)

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines
    • Restricted to Consultant Rheumatologists
    • See MHRA Drug Safety Update
    • See links below
  • RFL:
    • Approved for use in Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis and non-radiographic axial spondyloarthritis in line with NICE guidance
  • RNOH:
    • Rheumatology Consultants ONLY
    • Please prescribe by brand name Benepali or Enbrel - patients requiring 50 mg should be prescribed Benepali and patients requiring 25 mg should be prescribed Enbrel
    • See links below
  • UCLH:
  • WH:
    • As per NICE TA and above
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NICE TA195: Rheumatoid arthritis after the failure of a TNF inhibitor
Link  NICE TA199: Psoriatic arthritis
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for JIA
Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
 

Restricted Drug GP - Red View adult BNF  View SPC online  View childrens BNF  HCD
Golimumab
Restricted

Approved for:

  • Rheumatoid arthritis in line with the NCL RA pathway
  • Ankylosing Spondylitis (see NICE TAs)
  • Psoriatic Arthritis (PsA; see NICE TAs)

Provider notes

  • NMUH:
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines
    • Restricted to Consultant Rheumatologists
    • See links below
    • Check MHRA Drug Safety Updates
  • RFL:
    • Restricted to Rheumatology
    • Approved for use in Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis and non-radiographic axial spondyloarthritis in line with NICE guidance
  • RNOH:
    • Rheumatology Consultants ONLY.
  • UCLH:
  • WH
    • As per NICE TA and above
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NICE TA220: psoriatic arthritis
Link  NICE TA225: Golimumab for the treatment of rheumatoid arthritis after the failure of previous disease-modifying anti-rheumatic drugs
Link  NICE TA497: Golimumab for treating non-radiographic axial spondyloarthritis
Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
 

Restricted Drug GP - Red View adult BNF  View SPC online  View childrens BNF  HCD
Infliximab
Restricted

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Remsima is the brand of choice

Approved for:

  • Rheumatoid arthritis in line with the NCL RA pathway
  • Ankylosing Spondylitis (see NICE TAs)
  • Psoriatic Arthritis (PsA; see NICE TAs)

Provider notes

  • NMUH:
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • Restricted to Consultant Rheumatologists
    • See links below.
    • Check MHRA Drug Safety Updates.
  • RFL:
    • Approved for use in Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis and non-radiographic axial spondyloarthritis in line with NICE guidance
    • Approved for sarcoid (seek pharmacy advice)
    • Approved for use in neurosarcoid (Dr Kidd only)
  • RNOH:
    • Restricted for Rheumatology Consultants ONLY.
  • UCLH:
  • WH:
    • As per NICE TA and above
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NICE TA195: Rheumatoid arthritis (after failure of a TNF inhibitor)
Link  NICE TA199: Psoriatic arthritis
Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
 

Restricted Drug GP - Red View adult BNF  View SPC online  View childrens BNF  HCD
Ixekizumab injection
Restricted

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

See NICE TA for eligibility criteria

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • As per NICE guidance for the treatment of Psoriatic Arthritis
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
Link  NICE TA537: Ixekizumab for treating active psoriatic arthritis after inadequate response to DMARDs
 

Restricted Drug View adult BNF  View SPC online  View childrens BNF
Rituximab
Restricted

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Truxima brand is first choice (JFC March 2017).

Approved for:

  • Rheumatoid Arthritis; in line with the NCL RA pathway, including as monotherapy when methotrexate is C/I or not tolerated (July 2013)
  • ANCA associated vasculitis; in line with NHS England Commissioning Policy (May 2015)
  • Myositis (dermatomyositis and polymyositis); in line with NHS England Commissioning policy (September 2016)

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines
    • See links below
    • See MHRA Drug Safety Update
  • RFL:
    • Approved for use in rheumatoid arthritis, inflammatory myopathies, vasculitis and SLE
    • Seek advice from pharmacy prior to initiating treatment
    • See links below
  • RNOH:
    • Restricted to Rheumatology Consultants ONLY
    • See links below
  • UCLH:
  • WH:
    • As per NICE TA and above
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NHSE 16036/P: Rituximab for the treatment of dermatomyositis and polymyositis (adults)
Link  NICE TA195: Rheumatoid arthritis - after failure of a TNF inhibitor
Link  NICE TA308: Rituximab in combination with glucocorticoids for treating anti-neutrophil cytoplasmic antibody-associated vasculitis
Link  NHSE A13/P/a: Rituximab for the treatment of ANCA-associated vasculitis in adults
 

Restricted Drug GP - Red View adult BNF  View SPC online  View childrens BNF  HCD
Sarilumab
Formulary

See links below

Provider notes

  • NMUH:
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines - TO AWAIT UPDATED NCL JFC PATHWAY PRIOR TO PRESCRIBING
    • See links below
  • RFL:
    • As per NICE guidance
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • As per NICE TA and NCL JFC pathway
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NICE TA485: Sarilumab for moderate to severe rheumatoid arthritis
 

GP - Red View adult BNF  View SPC online  View childrens BNF
Secukinumab
Restricted

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for:

  • Ankylosing Spondylitis (see NICE TA)
  • Psoriatic arthritis (PsA; see NICE TA)

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines
    • Restricted to Consultant Rheumatologists 
    • See links below
  • RFL:
    • Approved for use in the treatment of Ankylosing Spondylitis and Psoriatic Arthritis in line with NICE guidance
  • RNOH:
    • Rheumatology Consultants ONLY
  • UCLH:
  • WH:
    • As per NICE TA and above
Link  
Link  NICE TA407: Secukinumab for active ankylosing spondylitis after treatment with non-steroidal anti-inflammatory drugs or TNF-alpha inhibitors
Link  NICE TA445: Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs
 

Restricted Drug GP - Red View adult BNF  View SPC online  View childrens BNF  HCD
Tocilizumab
Restricted

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for:

  • Rheumatoid arthritis in line with the NCL RA pathway (including without methotrexate [July 2013])
  • Juvenile Idiopathic Arthritis (JIA; see NICE TA)
  • Giant Cell Arteritis (see NICE TA)
  • Takayasu Arteritis - for RFL ONLY (JFC June 2017)
  • Adult-onset Stills disease in line with NHSE commissioning policy 170056P (JFC October 2018)

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines
    • Restricted to Consultant Rheumatologists
    • See MHRA Drug Safety Update
    • See links below
  • RFL:
    • Approved for Rheumatoid arthritis, Adult Onset Stills Disease (AOSD), Juvenile Idiopathic Arthritis, Giant Cell Arteritis and Takayasu Arteritis
  • RNOH:
    • Rheumatology Consultants ONLY
  • UCLH:
  • WH:
    • As per NICE TA and above
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NHSE 170056P: Anakinra/tocilizumab for the treatment of Adult-Onset Stillís Disease refractory to second-line therapy (adults)
Link  NICE TA238: Tocilizumab for the treatment of systemic juvenile idiopathic arthritis
Link  NICE TA247: Tocilizumab for the treatment of rheumatoid arthritis
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA518: Tocilizumab for treating giant cell arteritis
Link  NHSE 16056/P: Tocilizumab for Takayasu arteritis (adults)
 

Restricted Drug GP - Red View adult BNF  View SPC online  View childrens BNF  HCD
Tofacitinib tabs
Formulary

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for:

  • Rheumatoid arthritis (see NICE TA)
  • Psoriatic Arthritis (PsA; see NICE TA)

Provider notes

  • NMUH:
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines - TO AWAIT UPDATED NCL JFC PATHWAY PRIOR TO PRESCRIBING
    • See links below
  • RFL:
    • Approved for the use of Rheumatoid Arthritis and Psoriatic Arthritis in line with NICE guidance
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • As per NICE TA and above
Link  NICE TA480: Tofacitinib for moderate to severe rheumatoid arthritis
Link  NICE TA543: Tofacitinib for treating active psoriatic arthritis after inadequate response to DMARDs
Link  Tofacitinib - MHRA Drug Safety Update
 

GP - Red View adult BNF  View SPC online  View childrens BNF
Ustekinumab
Restricted

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for:

  • Psoriatic Arthritis (PsA; see NICE TA)

Provider notes

  • NMUH:
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines
    • Restricted to Consultant Rheumatologists 
    • See links below
    • Check MHRA Drug Safety Updates
  • RFL:
    • Psoriatic Arthritis in line with NICE guidance
  • RNOH:
    • Rheumatology consultants ONLY
    • See links below
  • UCLH:
  • WH:
    • As per NICE TA and above
    • Also see dermatology monograph

 

Link  NICE TA340: Ustekinumab for treating active psoriatic arthritis
 

Restricted Drug GP - Red View adult BNF  View SPC online  View childrens BNF  HCD
Anakinra
Non Formulary

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary

GP - Red View adult BNF  View SPC online  View childrens BNF  HCD