Rheumatology

Rheumatology Specialist formulary list

**Other indications for particular drugs may be included on completion of further specialist lists**

For information on use of unlicensed medicines or medicines used 'off-label' - click here

The following specialist medicines are approved for prescribing by or on the recommendation of a prescribing rheumatology specialist:

TAF SECTION	MEDICINE	SUMMARY OF RESTRICTED INDICATION	CATEGORY	PROTOCOL
10.1	Methotrexate (oral) - 2.5mg tablets ONCE WEEKLY	Rheumatoid arthritis (RA). Commonly used (unlicensed ‘off-label’) in other rheumatic disorders.		Rheumatology GP letter - methotrexate Rheumatology GP letter- methotrexate dose change Rheumatology GP letter - methotrexate with sulfasalazine (NHS Tayside Staffnet intranet links only)
	Methotrexate (parenteral) - injection (Metoject^®) ONCE WEEKLY	Rheumatoid arthritis, severe psoriatic arthritis.
		Commonly used (unlicensed ‘off-label’) in other rheumatic disorders.	Note: May be administered in primary care.
	Sulphasalazine e/c tablets	RA. Sero-negative spondyloarthropathy including psoriatic arthritis (unlicensed use ‘off-label’).		Rheumatology GP letter - sulfasalazine Rheumatology GP letter - methotrexate with sulfasalazine (NHS Tayside Staffnet intranet links only)
	Azathioprine tablets	RA. Commonly used (unlicensed ‘off-label’) in other rheumatic disorders.		Rheumatology GP letter - azathioprine (NHS Tayside Staffnet intranet link only).
	Ciclosporin capsules (specify brand name on prescription)	RA.		Rheumatology GP letter - ciclosporin (NHS Tayside Staffnet intranet link only)
	Cyclophosphamide injection	Induction therapy for severe systemic vasculitis, (including ANCA associated vasculitis (active granulomatosis with polyangiitis (Wegener’s) (GPA) and microscopic polyangiitis (MPA)), severe RA, systemic lupus erythematosus (SLE).		Cyclophosphamide protocol (NHS Tayside Staffnet intranet link only)
	Cyclophosphamide tablets	Induction therapy for severe systemic vasculitis, (including ANCA associated vasculitis (active granulomatosis with polyangiitis (Wegener’s) (GPA) and microscopic polyangiitis (MPA)), severe RA, systemic lupus erythematosus (SLE).		Cyclophosphamide protocol (NHS Tayside Staffnet intranet link only)
	Hydroxychloroquine sulphate tablets	RA, connective tissue diseases.		Rheumatology GP letter - hydroxychloroquine (NHS Tayside Staffnet intranet link only)
	Leflunomide tablets	RA and psoriatic arthritis.		Rheumatology GP letter - leflunomide (NHS Tayside Staffnet intranet link only)
	Minocycline tablets	RA (unlicensed use ‘off-label’).		Rheumatology GP letter – minocycline (NHS Tayside Staffnet intranet link only)
	Mycophenolate mofetil tablets	RA, SLE and inflammatory myopathy such as dermatomyositis and polymyositis (unlicensed use ‘off-label’).		Rheumatology GP letter - mycophenolate (NHS Tayside Staffnet intranet link only)
	Penicillamine tablets	RA.		Rheumatology GP letter - penicillamine (NHS Tayside Staffnet intranet link only)
	Sodium aurothiomalate (Myocrisin^®) intramuscular injection	RA, juvenile idiopathic arthritis.		Rheumatology GP letter - sodium aurothiomalate (NHS Tayside Staffnet intranet link only)
	Certolizumab pegol (Cimzia^®) injection	First choice TNF-alpha antagonist for RA (with methotrexate) when response to DMARDs including methotrexate inadequate. May also be used without methotrexate as an alternative to tocilizumab or other TNF-alpha inhibitors. First choice for severe active ankylosing spondylitis (AS) in patients who have had an inadequate response to, or are intolerant to NSAIDs. First choice for severe active axial spondyloarthritis without radiographic evidence of AS but with objective signs of inflammation by elevated CRP and/or MRI, who have had an inadequate response to, or are intolerant to NSAIDs. Alternative in severe active AS or severe active axial spondyloarthritis (without radiographic evidence of AS) in patients who have had an inadequate response or intolerance to another TNF-alpha inhibitor.		Shared Care Agreement – Biologic Therapies for Rheumatic Disease (NHS Tayside Staffnet intranet link only)
	Tocilizumab (RoActemra^®) concentrate for intravenous infusion	First choice for RA in patients who are intolerant to methotrexate or where continued treatment with methotrexate is inappropriate, when response inadequate/intolerance to previous therapy with one or more DMARDs or TNF-alpha antagonists. RA in combination with methotrexate when response to at least one DMARD or TNF-alpha inhibitor has been inadequate.		Shared Care Agreement – Biologic Therapies for Rheumatic Disease Tocilizumab protocol (NHS Tayside Staffnet intranet links only)
	Adalimumab (Humira^®) injection	RA (with or without methotrexate) when response to DMARDs inadequate. Active and progressive psoriatic arthritis and severe active ankylosing spondylitis when response to DMARDs inadequate. Severe axial spondyloarthritis without radiographic evidence of ankylosing spondylitis but with objective signs of inflammation by elevated CRP and/or MRI evidence of active inflammation despite NSAID therapy, or when there is an intolerance to NSAIDs		Shared Care Agreement – Biologic Therapies for Rheumatic Disease (NHS Tayside Staffnet intranet link only)
	Etanercept (Enbrel^®) injection	RA (with or without methotrexate) when response to DMARDs inadequate. Active and progressive psoriatic arthritis and severe active ankylosing spondylitis when response to DMARDs inadequate.		Shared Care Agreement – Biologic Therapies for Rheumatic Disease (NHS Tayside Staffnet intranet link only)
	Golimumab (Simponi^®) injection	RA (with methotrexate) when response to DMARDs inadequate. Restricted to use at a dose of 50mg only. Active and progressive psoriatic arthritis and severe active ankylosing spondylitis in patients who have responded inadequately to conventional therapy/when response to DMARDs inadequate. Restricted to use at a dose of 50mg only.		Shared Care Agreement – Biologic Therapies for Rheumatic Disease (NHS Tayside Staffnet intranet link only)
	Ustekinumab (Stelara^®) injection	Active psoriatic arthritis alone or in combination with methotrexate in patients who have responded inadequately to, or are unsuitable for, treatment with an anti-TNF.
	Infliximab (Remicade^®) intravenous infusion	RA (with methotrexate) when response to DMARDs inadequate.		Shared Care Agreement – Biologic Therapies for Rheumatic Disease (NHS Tayside Staffnet intranet link only)
	Rituximab (MabThera^®) concentrate for intravenous infusion	RA (with methotrexate) when response to DMARDs (including at least one TNF-alpha inhibitor) inadequate.		Shared Care Agreement – Biologic Therapies for Rheumatic Disease Rituximab protocol (NHS Tayside Staffnet intranet links only)
	Rituximab (MabThera^®) concentrate for intravenous infusion	In combination with glucocorticoids for induction of remission in severe, active granulomatosis with polyangiitis (Wegener’s) (GPA) and microscopic polyangiitis (MPA) in patients who have relapsed following cyclophosphamide or who are intolerant to or unable to receive cyclophosphamide.
	Abatacept (Orencia^®) concentrate for intravenous infusion	RA (with methotrexate) when response to DMARDs (including at least one TNF-alpha inhibitor) inadequate. Must have DAS 28 score >5.1 confirmed on two occasions, one month apart. Fourth line agent.		Abatacept protocol (NHS Tayside Staffnet intranet link only)
	Abatacept (Orencia^®) 125mg/mL solution for subcutaneous injection (pre-filled syringe)
	Febuxostat tablets (Adenuric^®)	Restricted to patients where allopurinol is inadequate, not tolerated or contraindicated.		Local protocol on the Management of gout

For further information on Tayside Rheumatology Services, including referral guidance and links to local, national and international guidance see the NHS Tayside Rheumatology website (NHS Tayside Staffnet intranet link only).

	May be prescribed by Hospital Specialists only
	May be prescribed in General Practice under the direction of a Specialist