8.1.1 Immune system disorders and transplantation
| First line drugs | Second line drugs | Specialist drugs | Secondary care drugs |
Traffic light status (TLS) explained:
- Green: Routine prescribing within licensed indication
- Amber 1: specialist recommendation followed by GP initiation and continuation
- Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
- Amber 3: specialist initiation and stabilisation followed by GP continuation
- Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
- Red: Hospital or specialist prescribing only
NHS England Circular SSC 1466. Renal Transplantation- Use of Immunosuppressants.
NHS England Clinical Commissioning Policy: Haematopoietic Stem Cell Transplantation (HSCT) (All Ages): Revised Reference: NHS England B04/P/a
Immune Sera and immunoglobulins
Immunoglobulins
Antithymocyte globulin (ATG) (rabbit)
- Renal, Immunology, Haematology and BMT Consultant use only, as per Trust protocol
Antithymocyte globulin (ATG) (horse)
- NHS England funded as per BCSH guideline
Immunosuppressants
Antimetabolites
Azathioprine for malignant conditions
Azathioprine (Amber SCG in development for non-malignant conditions)
- Tablets 25mg, 50mg
- Tablets 10mg - available on named-patient basis only u
Notes:
- Avoid concomitant use of azathioprine with allopurinol, unless supervised by an appropriate specialist.
- Monitoring of azathioprine is essential.
Calcineurin Inhibitors and related drugs
Ciclosporin (Amber SCG in development)
- Neoral®capsules 10mg, 25mg, 50mg, 100mg
- Sandimmun® concentrate for IV infusion 250mg in 5mL (Hospital only)
Notes:
- Patients should be stabilised on a particular brand of oral ciclosporin because switching between formulations without close monitoring may lead to clinically important changes in blood-ciclosporin concentration.
- Prescribing and dispensing of ciclosporin should be by brand name to avoid inadvertent switching.
- If it is necessary to switch a patient to a different brand of ciclosporin, the patient should be monitored closely for changes in blood-ciclosporin concentration, serum creatinine, blood pressure, and transplant function.
Sirolimus (Amber 3)
- Tablets 500mcg, 1mg and 2mg
- Oral solution 1mg/mL
Notes:
- The 500mcg (i.e. 0.5mg) tablet is not bioequivalent to the 1mg and 2mg tablets.
- Multiples of 0.5mg tablets should not be used as a substitute for other tablet strengths.
Tacrolimus
- Adoport® capsules 500mcg and 1mg
- Modigraf®granules 200mcg and 1mg sachet packs
Notes:
- Drug Safety Update: Oral tacrolimus products: reminder to prescribe and dispense by brand name only (November 2017)
- Switching between different oral formulations of Tacrolimus requires careful therapeutic monitoring. Changes to oral tacrolimus therapy should be made only under the close supervision of a transplant specialist.
- The three different pharmaceutical forms of oral tacrolimus products are shown below, together with brand names of currently approved products.
- Immediate release capsule taken twice a day (including the following brands - Adoport, Aletris, Capexion, Evenil, Miloprosan, Prograf, Tacni, Takon, Taliximun, Tamitect and Vivadex)
- Prolonged release capsule taken once daily (Advagraf)
- Granules for oral solution taken twice daily (Modigraf).
Monoclonal Antibodies
Canakinumab
- Ilaris® Injection, powder for reconstitution, 150mg vial
Monoclonal Antibodies (Anti-lymphocyte)
Basiliximab
- Simulect® Injection 10mg, 20mg
Notes:
- Use as per NICE TA482: Immunosuppressive therapy for kidney transplant in children and young people (October 2017)
- Use as per NICE TA481: Immunosuppressive therapy for kidney transplant in adults (October 2017)
Belimumab
- Benlysta® Intravenous infusion, powder for reconstitution 120mg, 400mg vials
Note:
- Use as per NICE TA397: Belimumab for treating active autoantibody-positive systemic lupus erythematosus (June 2016)
Purine Synthesis Inhibitors
Mycophenolate Mofetil (In renal patients)
Mycophenolate Mofetil (Amber SCG, DMARD SCG )
- Capsules 250mg (generic)
- Tablets 500mg (generic)
- Oral suspension 1g in 5mL
Notes:
- Mycophenolate Mofetil: new pregnancy-prevention advice for women and men
Traffic light status (TLS) explained:
- Green: Routine prescribing within licensed indication
- Amber 1: specialist recommendation followed by GP initiation and continuation
- Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
- Amber 3: specialist initiation and stabilisation followed by GP continuation
- Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
- Red: Hospital or specialist prescribing only
Return to Chapter: 8. Immune System and Malignant Disease
Last updated by: Dupe Fagbenro on 05-02-2019 14:23
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BNF
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NICE
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Summary of product characteristics
