Consultations: DOAC statement and hypersalivation pathway

Two new consultations have been opened on the GMMMG site; see details below. Both consultations will run until 5pm on Monday 1st August 2022. Comments can be submitted using the feedback forms on the GMMMG consultations page, and comments are invited from all stakeholders.

DOAC statement

CRG seek comments from Greater Manchester on this position statement regarding the prescribing of best value direct oral anticoagulants (DOACs) for stroke prevention in atrial fibrillation. When developing the statement CRG carefully considered, amongst other things:

  • The financial savings associated with increased edoxaban use,
  • A clinician’s freedom to prescribe the treatment they think is most appropriate for their patient
  • The available evidence base to support (or not) the use of one medicine over another.
  • The Investment and Impact Fund indicators
  • The high court ruling that has invalidated the patent for apixaban, and may yet be subject to appeal.

CRG want edoxaban to be the first choice DOAC for use in non-valvular AF, and an alternative used where edoxaban would not be safe or appropriate. This position is still current at the time of publication of the draft statement, despite the legal issues surrounding apixaban.

GMMMG therefore seek feedback from a wide range of stakeholders regarding this statement.

Hypersalivation pathway

CRG seek comments from Greater Manchester on this draft pathway for the management of hypersalivation. It has been developed and approved by MFT and CRG are seeking to adapt it for use across GM, particularly in primary care.

It looks to provide evidence-based, cost-effective recommendations on the management of hypersalivation in a number of conditions.

GMMMG therefore seek feedback from a wide range of stakeholders regarding this pathway

Consultation: actions from June meeting of CRG

On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at the June 2022 CRG meeting.

Actions in this consultation include:

  • Minoxidil foam to be DNP, and formulary updated to clarify that other topical minoxidil preparations are not prescribable
  • Lixisenatide to be removed from formulary following discontinuation of initiation packs
  • Romosozumab for severe osteoporosis to be RED, and added to formulary as a first line anabolic treatment alongside teriparatide
  • Selumetinib for symptomatic and inoperable plexiform neurofibromas to be RED
  • Links to NICE clinical guidance on baricitinib for COVID-19 to be added to formulary in chapters 10 & 13.

For information:

  • Epiduo gel: strength to be removed from formulary, to align with primary care dermatology acne pathway
  • Brand name and formulation for topical calcipotriol / betamethasone to be removed from formulary, and replaced with a statement that prescribers should choose the most cost-effective option.
  • Formulary restriction to macrogol 3350 to be removed, replaced with a statement that prescribers should choose the most cost-effective macrogol formulations.

To take part in this consultation, visit the consultations page. The consultation period is open until 5pm on Thursday 28th July 2022

Consultation: actions from May meeting of CRG

On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at the May 2022 CRG meeting.

Actions in this consultation include:

  • Sitagliptin to replace alogliptin as first choice DPP4 inhibitor
  • Anti-reflux formula milks to be DNP
  • Nirmatrelvir & ritonavir (Paxlovid) to be added to formulary as RED
  • Links to NICE clinical guidance to be added to formulary: NG215 (medicines associated with dependence or withdrawal symptoms) and NG217 (epilepsies in children, young people and adults).
  • Links to MHRA safety advice to be added to formulary: pregabalin: findings of safety study on risks during pregnancy

To take part in this consultation, visit the consultations page. The consultation period is open until 5pm on Thursday 30th June 2022.

Consultations: CRG actions and draft shared care protocol

Two new consultations have been opened on the GMMMG consultations page

CRG actions

On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at the April 2022 CRG meeting. Actions in this consultation include:

  • Simple eye ointment – DNP
  • Goserelin and leuprorelin for male early or advanced breast cancer – AMBER (see also consultation on updated draft shared care protocol)
  • Empagliflozin for chronic heart failure – GREEN following specialist advice
  • Dapagliflozin for chronic kidney disease – GREEN
  • Phenazone/lidocaine eardrops – add to formulary for treatment of otitis media
  • Pitolisant for excessive daytime sleepiness caused by obstructive sleep apnoea – DNP
  • Solriamfetol for excessive daytime sleepiness caused by obstructive sleep apnoea – DNP
  • Pegcetacoplan for paroxysmal nocturnal haemoglobinuria – RED
  • Atidarsagene autotemcel for metachromatic leukodystrophy – RED

Shared care protocol: GnRH analogues for breast cancer

CRG seek comments on this updated shared care protocol for the treatment of breast cancer.

The main changes are:

  • The addition of leuprorelin within the indications listed in the SCP
  • The SCP now includes the treatment of male breast cancer within the indications detailed in the SCP
  • A move to the new approved GM shared care protocol format.

Both consultations will run until 5pm on Wednesday 25th May 2022. Comments can be submitted using the feedback forms on the GMMMG consultations page, and comments are invited from all stakeholders.

Consultation: inclisiran information for primary care prescribers

A new consultation has been opened on the GMMMG consultations page on a draft information leaflet for inclisiran. 

The draft provides additional advice and information for prescribers, and is intended to support primary care prescribers and ensure a quality standard for the prescribing of inclisiran.

The consultation will be open until 5pm on Tuesday 3rd May 2022, and comments are invited from all stakeholders.

Consultation: actions from March meeting of CRG

On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at the March 2022 CRG meeting.

Actions in this consultation include:

  • Moxonidine – GREEN following specialist initiation
  • Ponesimod for relapsing-remitting multiple sclerosis – RED
  • Upadacitinib for active psoriatic arthritis – RED
  • Palforzia for peanut allergy in children and young people – RED on the paediatric RAG list, and GREY and RED on the adult RAG list, only for use in people aged 18 and over if treatment is started between the ages of 4 and 17, as per NICE guidance
  • Odevixibat for progressive familial intrahepatic cholestasis – RED

To take part in this consultation, visit the consultations page. The consultation period is open until 5pm on Thursday 21st April 2022.

Consultation: actions from February meeting of CRG

On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at the February 2022 CRG meeting.

Actions in this consultation include:

  • Modafinil for narcolepsy and in Parkinson’s disease: GREEN following specialist initiation
  • Dacepton (apomorphine): AMBER; to be added to existing shared care protocol
  • Bempedoic acid: GREEN following specialist advice (previously specialist initiation)
  • Sotrovimab for COVID-19: RED
  • Mexiletine for myotonia: RED
  • Liraglutide for obesity in people aged 12-17: Do Not Prescribe
  • Dupilumab for severe asthma: RED
  • Belimumab for SLE: RED
  • Cenobamate for epilepsy: GREEN following specialist initiation (by a tertiary epilepsy service)
  • Risdiplam for spinal muscular atrophy: RED
  • Solriamfetol for narcolepsy: RED
  • Fostamatinib for chronic ITP: Do Not Prescribe

To take part in this consultation, visit the consultations page. The consultation period is open until 5pm on Monday 4th April 2022.

New consultations: high cost drugs pathways

Two new consultations have been opened on the GMMMG consultations page. The topics are:

  • High cost drugs pathway: psoriatic arthritis
  • High cost drugs pathway: axial spondyloarthritis

These consultations will be open until 5pm on Thursday 22nd March 2022, and comments are invited from all stakeholders.

GMMMG are mindful of additional service pressures at present therefore if you foresee any problems giving input on these consultations, or if you have any questions, please contact the secretariat at nuth.enquires.gmmmg@nhs.net.

New consultations: pathway updates and formulary amendments

A batch of new consultations has been opened on the GMMMG consultations page. The topics include:

  • Actions from the December meeting of CRG
  • Updated rheumatoid arthritis high cost drugs pathway
  • Updated neuropathic pain pathway
  • Updated headache pathway
  • Updated primary care rebate scheme ethical framework

Each of these consultations will be open until 5pm on Monday 14th February, and comments are invited from all stakeholders.

GMMMG are mindful of additional service pressures at present, therefore these consultations will run for eight weeks instead of the usual six. Every effort has been made to allow sufficient time for appropriate clinical input to these documents, but if you foresee any problems or have any questions please contact the secretariat at nuth.enquires.gmmmg@nhs.net.

Consultation: actions from November meeting of CRG

On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at the November 2021 CRG meeting.

Actions in this consultation include:

  • Insulin aspart Sanofi (Trurapi) to be added to formulary as a GREEN drug and first line option for rapid acting insulin.
  • Haloperidol 500 microgram tablets to be DNP (criterion 2)
  • Berotralstat for hereditary angioedema to be added to the RAG list as a RED drug
  • Casirivimab/imdevimab (Ronapreve)® to be added to formulary as a RED drug, with link to NG191

To take part in this consultation, visit the consultations page. The consultation period is open until 5pm on Thursday 23rd December 2021.