Leflunomide – Rheumatoid arthritis and psoriatic arthritis

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

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

April 2000: Use in rheumatoid arthritis supported.

September 2008: Extended use in psoriatic arthritis supported.

November 2008: Revised shared care agreement approved by the TAG.

March 2009: The TAG noted the NICE Clinical Guideline No.79 – Management of Rheumatoid Arthritis in adults.

November 2010: Shared care agreement reapproved with no changes.

January 2013: Shared care agreement reapproved with no changes.

July 2015: Shared care agreement reapproved with no significant changes

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.

Shared care prescribing information available via Knowledge Management http://nww.knowledgeanglia.nhs.uk/tag/tag_guidance.htm

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