812 Multiple Sclerosis - Milton Keynes Formulary

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8.1.2 Multiple Sclerosis

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

Multiple sclerosis: NHS England funded via Prior Approval Scheme on Blueteq 

Immunostimulants: Interferons 

Interferon beta-1a

• Avonex^® Injection, 30mcg (6 million-unit) powder and solvent for solution (BIO-SET)
• Avonex^® Injection, 30mcg/0.5mL (6 million-unit) solution in Pre-filled syringe 
• Avonex^® Injection, 30mcg/0.5mL (6 million-unit) solution in Pre-filled pen
• Rebif^® Injection, 22mcg (6 million-unit) prefilled syringe or pen
• Rebif^® Injection, 44mcg (12 million-unit) prefilled syringe or pen
• Rebif^® Injection, 44mcg (12 million-units/mL) 1.5mL (66mcg, 18 million-unit) cartridge
• Rebif^® Injection, 88mcg (24 million-units/mL) 1.5mL (132mcg, 36 million-unit) cartridge

Note:

• Use as per NICE TA527: Beta interferons and glatiramer acetate for treating multiple sclerosis (June 2018)

Interferon beta-1b

• Betaferon^® Injection, 300mcg (9.6 million-unit) powder for reconstitution, vial with diluent
• Extavia^® Injection, 300mcg (9.6 million-unit), powder for reconstitution, vial with diluent

Note:

• Use as per NICE TA527: Beta interferons and glatiramer acetate for treating multiple sclerosis (June 2018)

Peginterferon beta-1a

• Plegridy^® Injection, 63mcg/0.5mL solution in Pre-filled pen

• Plegridy^® Injection, 94mcg/0.5mL solution in Pre-filled pen

• Plegridy^® Injection, 125mcg/0.5mL solution in Pre-filled pen

Immunostimulants: others 

Glatiramer acetate

• Copaxone^® Injection, Glatiramer acetate 20mg/mL solution in Pre-filled syringes

• Copaxone^® Injection, Glatiramer acetate 40mg/mL solution in Pre-filled syringes

Note:

• Use as per NICE TA527: Beta interferons and glatiramer acetate for treating multiple sclerosis (June 2018)

Immunosuppressants: Immunomodulating drugs  

Dimethyl fumarate 

• Tecfidera® Capsules 120mg, 240mg

Note:

• Use as per NICE TA320: Dimethyl fumarate for treating relapsing?remitting multiple sclerosis (August 2014)

Fingolimod  

• Gilenya^® Capsules 500mcg 

Notes: 

• Drug Safety Update: MHRA: Fingolimod (Gilenya): Updated advice about risk of cancers and serious infections (December 2017) 

• Drug Safety Update: MHRA: Fingolimod (Gilenya): new contraindications in relation to cardiac risk (December 2017) 

• Letter to Healthcare Professionals (April 2015) 

• Drug Safety Update: MHRA: Fingolimod (Gilenya): not recommended for patients at known risk of cardiovascular adverse events (December 2014 ) 

• Use as per NICE TA254: Fingolimod for the treatment of highly active relapsing-remitting multiple sclerosis (April 2012)

Immunosuppressants: Interleukin inhibitors

Daclizumab 

• Zinbryta^® Solution for injection 150mg/1mL in pre-filled syringe / in pre-filled pen

Notes:

• Drug Safety Update: Daclizumab beta (Zinbryta▼): risk of immune-mediated encephalitis – some cases several months after stopping treatment (Sept 2018)

• Drug Safety Update: Daclizumab and risk of severe liver injury: new restrictions to use and strengthened liver monitoring (January 2018)

• Use as per NICE TA441: Daclizumab for treating relapsing–remitting multiple sclerosis (April 2017)

   

   

Immunosuppressants: Monoclonal antibodies: Anti-lymphocyte

Alemtuzumab

• Lemtrada^® Concentrate for IV infusion 10mg/mL

Note:

Use as per NICE TA312: Alemtuzumab for treating relapsing-remitting multiple sclerosis (May 2014)

Natalizumab

• Tysabri^® Concentrate for IV infusion 20mg/mL

Note:

• Use as per NICE TA127: Natalizumab for the treatment of adults with highly active relapsing-remitting multiple sclerosis (Aug 2007)

Ocrelizumab

• Ocrevus^® Solution for infusion 30mg per ml 

Note:

• Use as per TA585: Ocrelizumab for treating primary progressive multiple sclerosis (June 2019)

• Use as per NICE TA533: Ocrelizumab for treating relapsing-remitting multiple sclerosis (July 2018)

Immunosuppressants: Pyrimidine Synthesis Inhibitors

Teriflunomide

• Aubagio^® 14mg tablets

Note:

• Use as per NICE TA303: Teriflunomide for treating relapsing-remitting multiple sclerosis (Jan 2014)

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: Sheila Wood on 06-08-2019 12:08