Formulary and subgroup decision updates
Following approval by GM ICB exec, the following decisions have been approved and published:
- Dexamethasone intravitreal implant for diabetic macular oedema – formulary updated to reflect updated NICE guidance.
- Avacopan to severe active granulomatosis with polyangitis or microscopic polyangiitis add to RAG
list as RED. - Ozanimod for moderately to severely active ulcerative colitis added to formulary as RED.
- Upadacitinib for active ankylosing spondylitis added to formulary as RED.
- Relugolix–estradiol–norethisterone acetate for treating moderate to severe symptoms of uterine fibroids added to formulary as GREEN (following specialist advice).
The formulary has also been updated to reflect relevant 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.
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
Consultation: actions from February 2023 meeting of CRG
On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at the February 2023 CRG meeting.
Actions in this consultation include:
- Upadacitinib for moderately to severely active ulcerative colitis, as recommended in NICE TA856, to be RED.
- Maribavir for refractory cytomegalovirus infection after transplant, as recommended in NICE TA860, to be RED.
- Preparations of Insuman which are scheduled for discontinuation in 2023 to be removed from formulary. Humulin I will replace Insuman Basal as the first choice isophane insulin.
- Metformin 1g immediate-release tablets added to DNP list (criterion 2: Products which are clinically effective but where more cost-effective products are available, including products that have been subject to excessive price inflation).
- Colesevelam 625mg tablets and colestyramine 4g oral powder for CVD prevention in hyperlipidaemia to be GREEN (specialist advice) and GREY (criterion 1): for use when there is no alternative treatment option due to intolerance, or ineligibility for PCSK9i or Inclisiran treatment.
- Potassium permanganate 400mg tablets for solution to be RED.
- Morphine sulphate orodispersible tablets added to formulary as an alternative to morphine sulphate oral solution 10mg/5mL and morphine sulphate tablets, with a RAG status of GREEN.
- Trifarotene 50 microgram/g cream for acne to be GREEN
- IQoro neuromuscular training device for stroke-related dysphagia, hiatus hernia and other indications to be DNP for all indications.
All links to MHRA drug safety updates will be added to formulary as appropriate.
To take part in this consultation, visit the consultations page. The consultation period is open until 5pm on Thursday 30th March 2023.
Updated lipid pathway
The lipid management pathway for secondary prevention of cardiovascular disease has been updated. Changes include:
- A statement has been added to ensure statin intolerance pathway has a clear emphasis
- Further highlighting of the position of icosapent ethyl (Vazkepa®)
- Inclisiran option for prescribing has been made clearer
The updated pathway is available on the clinical guidance and pathways page, along with links to other lipid management resources.
New guidelines and Terms of Reference
Following approval by CRG, GMMMG, and the Greater Manchester ICS Clinical Effectiveness and Governance Committee, two new GMMMG guidelines have been published;
- HRT Guidance for Menopause Management
- Hypersalivation and Sialorrhoea in Adult Patients
Both guidelines are available on the clinical guidance and pathways page.
The formulary and RAG list have been updated to reflect the recommendations in these guidelines. For details of the updates, see the GM formulary change log, available on the formulary page.
The Terms of Reference for GMMMG and its subgroups have also been approved, and are available here. These include:
- Clinical reference group
- Medicines safety group
- Population health management and health inequalities group
- Digital group
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.
Consultation: actions from January 2023 meeting of CRG
On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at the January 2023 CRG meeting.
Actions in this consultation include:
- Avatrombopag added to formulary as a RED drug for primary chronic immune thrombocytopenia.
- Esketamine nasal spray for treatment-resistant depression added to the DNP list.
All links to MHRA drug safety updates will be added to formulary as appropriate.
To take part in this consultation, visit the consultations page. The consultation period is open until 5pm on Monday 6th March 2023.
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.
Updated shared care protocols: potassium binders and atypical antipsychotics
Following approval by CRG and GMMMG, and by the Greater Manchester ICS Clinical Effectiveness and Governance Committee, the following revised GMMMG shared care protocols for adult patients are now available:
- Sodium zirconium cyclosilicate for hyperkalaemia
- Patiromer sodium for hyperkalaemia
- Oral atypical antipsychotics
The formulary has been updated to assign an AMBER status sodium zirconium cyclosilicate, patiromer sodium, lurasidone, and paliperidone.
The updated documents can be found on the shared care page, along with all other currently active SCPs.
Consultation: actions from December meeting of CRG
On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at the December 2022 CRG meeting.
Actions in this consultation include:
- Donepezil, galantamine and rivastigmine for mild to moderate Alzheimer’s disease, Lewy body dementia, and Parkinson’s disease: Green (specialist advice)
- Cyclogest added to formulary as an option for vaginal micronised progesterone for prevention of miscarriage
All links to MHRA drug safety updates will be added to formulary as appropriate.
To take part in this consultation, visit the consultations page. The consultation period is open until 5pm on Thursday 26th January 2023.