Ciclosporin (Various brands – to be specified by prescribers) – Rheumatic and dermatological diseases.

Overview | Rheumatoid arthritis in adults: management | Guidance | NICE

NICE recommendations, summary of meeting discussions, links to additional supporting docs etc.

Guidance developed initially in relation to second-line drugs in the treatment of Rheumatoid Arthritis) and later extended to cover use of ciclosporin in psoriasis. GPs can opt for a shared care arrangement whereby they claim a fee for monitoring patients for whatever indication the patient is taking the medication. Details of claims to be confirmed with individual PCT prescribing advisers.

July 2011: The TAG supported a shared care proposal for use in rheumatology and dermatology developed by the NNUH (with input from the JPUH), subject to recommended amendments being finalised.

The TAG’s recommendation was supported and approved by the NHS Norfolk Drug & Therapeutics Commissioning Group on 21st July 2011.

September 2017:  The local Shared Care Agreement was updated following the publication of the revised BSR and BHPR guidelines for the prescription and monitoring of non-biologic disease-modifying drugs 2017.

September 2018:

The TAG noted NICE NG 100 (July 2018) – Management of rheumatoid arthritis in adults, which included new and updated recommendations on:

*           investigations following diagnosis

* treat-to-target strategy and initial pharmacological management

* symptom control and monitoring

and also:

* investigations for diagnosis and referral from primary care

* non-pharmacological management and the multidisciplinary team

* communication and education

September 2018:

NICE NG 100 (July 2018) was noted by the N&W CCGs’ Drugs & Therapeutics Committee

September 2018:

The TAG noted and a revised Specialist Treatment Pathway for Rheumatoid Arthritis which had been updated with the most recent advice on adalimumab. The place of baricitinib was also clarified.

The TAG was advised that (biosimilar) adalimumab (once available) would remain as the CCGs’ preferred 1st line (biologic) treatment option; a JAK inhibitor would be considered only where biologics are contraindicated.

Any further comments from the Trusts regarding the order of use of NICE-recommended therapies within the pathway to be submitted to the CSU’s Specialist Interface Pharmacist.

The TAG otherwise agreed with the treatment pathway in principle.

September 2018:

The N&W Drugs & Therapeutics Committee (D&TC) noted and supported the TAG’s recommendations