Neuropathic pain guidance updated

Following technical review and Greater Manchester-wide consultation, the GMMMG neuropathic pain guidance has been updated and is now available on the Clinical Guidance and Pathways page. The formulary has also been updated to reflect the guidance.

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.

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.

Updated asthma pathway published

Following GM-wide consultation and approval by chief finance officers and directors of commissioning, an updated GMMMG asthma guideline is now available on the Clinical Guidance and Pathways page.

The guideline has been updated in response to a request from GMHSCP to produce an updated asthma management plan to support the move to lower carbon inhalers. This includes consciously reducing the propellants contained in metered-dose inhalers which is a significant contributor to enabling the Greater Manchester Combined Authority’s and Greater Manchester Joint Commissioning Board’s commitment to sustainability.

An updated inhaler guide to support the pathway is in production, and will be available in due course.

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.

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.

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.

Voluntary Recall of Alimentum and Elecare Infant Formula Powders (Abbott)

Abbott have issued a voluntary recall of Alimentum Similac and Elecare Similac infant formula powders due to concerns of possible contamination with Salmonella Newport and Cronobacter sakazakii. Both products are used for special medicinal purposes, including the management of cow’s milk protein allergy (CMPA).

Anyone who has purchased or been prescribed Alimentum or Elecare should be advised not to feed it to their baby and to return it to the place they got it from. A suitable alternative feeding solution should be recommended.

The GMMMG CPMA guidance includes other infant formula powder options that may be considered as appropriate for individual patients.

Abbott can be contacted on 01795 580303 for information on how to return the product.

Further information:

Food Standards Agency recall

National Patient Safety Alert

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.

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.