New and updated resources

Following approval by CRG, GMMMG, and the Greater Manchester ICS Clinical Effectiveness and Governance Committee, the following documents have been approved and published.

The GMMMG Inappropriate Polypharmacy Review and Treatment Optimisation: Resource Pack has been reviewed and updated. The updated resource pack is available on the Clinical Guidelines and Pathways page.

Terms of reference for the Workforce subgroup have also been approved, and are available on the Membership and Terms of Reference page.

The formulary and RAG list have been updated to remove fostamatinib from the RAG list and assign a RED RAG status, and to reflect updated NICE guidelines and MHRA advice. See formulary change log for more details.

Outstanding decisions

Outstanding decisions expected to have a financial impact for the ICS are pending financial approval from by GM Directors of Finance, and will be published once approved. These include:

  • Dexamethasone intravitreal implant for diabetic macular oedema
  • Avacopan to severe active granulomatosis with polyangitis or microscopic polyangitis
  • Ozanimod for moderately to severely active ulcerative colitis
  • Upadacitinib for active ankylosing spondylitis
  • Relugolix–estradiol–norethisterone acetate for treating moderate to severe symptoms of uterine fibroids
  • Implementation of NICE guidance on Continuous Blood Glucose Monitoring (CGM)
  • Dexcom ONE rtCGM device
  • GMMMG antimicrobial guidance

Formulary and subgroup decision updates

Following approval by CRG, GMMMG, and the Greater Manchester ICS Clinical Effectiveness and Governance Committee, the following decisions have been approved and published:

  • Insuman Comb 50 removed from formulary – product discontinued
  • Abrocitinib, tralokinumab & upadacitinib added for formulary as RED drugs in chapter 13

The formulary has also been updated to reflect relevant NICE guidelines and safety alerts. For full details please see the formulary change log, which is available on the formulary page.

For more information on these and other decisions, please see GMMMG decision summaries.


Formulary and subgroup decision updates

Following approval by CRG, GMMMG, and the Greater Manchester ICS Clinical Effectiveness and Governance Committee, the following decisions have been approved and published:

  • The RAG status for modafinil for excessive sleepiness in narcolepsy or Parkinson’s disease has been updated to GREEN (following specialist initiation), and an information leaflet for primary care prescribers has been published.
  • Famotidine added to formulary as GREEN, in place of ranitidine
  • Metolazone – recommendation added to prescribe by brand
  • Icosapent ethyl – GREEN (specialist advice)
  • Fenfluramine – RED for Dravet syndrome
  • Imlifidase – RED
  • Roxadustat – RED
  • Setmelanotide – RED

The formulary has also been updated to reflect relevant NICE guidelines and safety alerts.

For more information on these and other decisions, please see GMMMG decision summaries.


Formulary and subgroup decision updates

Following approval by CRG, GMMMG, the Greater Manchester ICS Clinical Effectiveness and Governance Committee, and Greater Manchester Management Executive, the following decisions have been approved and published:

  • Dapagliflozin for chronic kidney disease added to formulary as a GREEN drug
  • Edoxaban approved as first-line DOAC in atrial fibrillation, and DOAC statement published.
  • Sitagliptin approved as first-choice DPP-4 inhibitor
  • Romosozumab for severe osteoporosis added to formulary as a RED drug, as an alternative first-choice option alongside teriparatide
  • Simple eye ointment assigned a Do Not Prescribe status

Decision summaries from the July, August, and September meetings of GMMMG are also available, with further details on these and other decisions from those meetings. The formulary and RAG list change log has been updated accordingly and is available on the formulary page.


Formulary and subgroup decision updates

Following approval by GMMMG, the website and formulary have been updated to reflect decisions made by GMMMG and the Clinical Reference Group (CRG). This includes:

  • Restriction to macrogol 3350 removed, and statement added directing prescribers to choose the most cost-effective macrogol
  • Moxonidine: GREEN (following specialist initiation). Clarification of previous position.
  • Palforzia for peanut allergy: RED, and GREY, only for use in adults if treatment was started between the ages of 4 & 17.
  • Ponesimod for multiple sclerosis: RED.
  • Brand name & formulation for calcipotriol/betamethasone removed and replaced with advice to choose the most cost-effective option.
  • Strength of Epiduo gel removed, to align with primary care acne pathway.
  • Odevixibat (RAG list only): RED,

The formulary has also been updated to reflect relevant NICE guidelines and safety alerts. For full details of the changes, please see the Formulary Change Log and GMMMG decision summaries.

Formulary and subgroup decision updates

Following the May meeting of GMMMG, the website and formulary have been updated to reflect decisions made by GMMMG and the Clinical Reference Group (CRG). This includes:

  • Bempedoic acid: GREEN following specialist advice (previously specialist initiation)
  • Sotrovimab for COVID-19: 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

The formulary has also been updated to reflect relevant NICE guidelines and safety alerts. For full details of the changes, please see the Formulary Change Log and GMMMG decision summaries.

GMMMG decision summaries

Summaries of decisions made by GMMMG and its subgroups are now available on the decision summaries page. These documents provide stakeholders with an overview of the decisions made, and issues considered.

Summaries will be published after each meeting of GMMMG and include decisions and actions from meetings of CRG, MGSG, and GMMMG.

Formulary and subgroup decision updates

Following the March meeting of GMMMG, the formulary has been updated to reflect decisions made by the Clinical Reference Group (CRG) and Medicines and Guidelines Subgroup (MGSG). Changes include:

  • Addition of NICE guidance and MHRA drug safety updates to formulary
  • Insulin aspart biosimilar (Trurapi) added to formulary as the first choice rapid acting insulin analogue, as a GREEN drug
  • Haloperidol 500 microgram tablets added to the DNP list (criterion 2)
  • Berotralstat added to the RAG list as a RED drug

For full details of the changes, please see the Formulary Change Log.