GREAT WESTERN HOSPITALS NHS FOUNDATION TRUST. Formulary Working Group 2.00pm 19 th January 2017 Radiology Room, Ground Floor, GWH

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1 Formulary Working Group 2.00pm 19 th January 2017 Radiology Room, Ground Floor, GWH The 3T s Formulary Swindon CCG & Wiltshire CCG Great Western Hospitals NHS Foundation Trust (In collaboration with Avon and Wiltshire Mental Health Partnership and Oxford Health NHS Foundation Trust Attendees: Dr Francis Campbell (FC) (chair) Magda Blahut-Zugaj (MB) Lisa King () Dr Rachel Hobson (RH) Dr Anna Collings (AC) Surinder Bassan (SB) Terri Turner (TT) Mair Robinson (MR) Paul Clarke (PC) (mins) Harpreet Rajput (HR) (from 3pm) Apologies Dr Sherlie Arulanandam (SA) Dr Peter Mack (FC) GP representative, Swindon GWH Consultant representative Formulary Pharmacist, GWH Formulary Pharmacist, Wiltshire CCG GP representative, Wiltshire CCG Director of Pharmacy and Medicines Optimisation, GWH Pharmacist AWP Medicines Management Pharmacist, Wiltshire CCG Pharmaceutical Advisor, Swindon CCG Deputy Director of Pharmacy and Medicines Optimisation, GWH Consultant Psychiatrist, AWP GP Representative, Swindon Agenda Item 1 APOLOGIES Description Action by whom 2 3 MINUTES OF LAST MEETING Minutes of the last meeting with minor amendments were agreed as accurate. to amend and upload pdf version to formulary website and forward to TPC for information. MATTERS ARISING Please see action tracker for progress on actions from last meeting and plan to expedite matters arising. Of particular note: GWH Dermatology Meeting Notes from the meeting on were shared. With a few exceptions, GWH dermatologists were happy with the proposed changes to the first line emollients. However TVN opinion is that an emollient containing is glycerine is required. RH will check the evidence for this and meet with at SFT dermatologists before finalising the emollient guidance and bringing back to the revised guidance to the group. Valproic Acid Shared Care Agreement. The group was happy, that now that new guidance has been agreed, there is no longer a need for a Valproic acid SCA. will amend formulary accordingly. Linaclotide. The gastroenterologists have stated they do not have the capacity to follow up patients 4 weeks after initiation. The group proposed GPs could make the decision about whether the drug was working and should be continued if specific criteria for stopping were included in the discharge letter sent to the GP (this letter is also copied to the patient). to work with the gastroenterologists on the content of the letter. ALL RH T:\Pharmacy\3 T's Formulary\FWG Meetings\FWG Minutes\Mins_2017\FWG_Minutes_19 January 2017.Doc Page 1 of 5

2 4 4.1 CHAPTER/SECTION UPDATES High strength insulins It was noted that there has already been a safety incident in a neighbouring CCG where the contents were removed from a high strength insulin pen using an insulin syringe, in order that the nurse could use a safety needle rather than a pen needle. RH tabled a document outlining the risks and befits of the high strength insulins Toujeo and Degludec 200units/ml. Toujeo It was noted that 2 out of 3 RCTs had shown a statistically significant reduction in confirmed or severe nocturnal hypoglycaemia in Type 2 diabetics with Toujeo compared to Lantus, equating to approx 1 less event per person per year. However, it was also noted that this had not been demonstrated for Type 1 diabetics; that clinical trials had shown no difference in pain at injection site with Toujeo compared to Lantus despite smaller injection volume; that EPAR states the more gradual glucose lowering with Toujeo compared to Lantus did not translate to important advantages; that NICE evidence summary states that limitation of device to 80 units per injection negates the most obvious advantage of Toujeo. Degludec 200untis/ml It was noted that 2RCTs had shown a statistically significant reduction in nocturnal hypoglycaemia in Type 1 diabetics of between 1.4 and 4 episodes per patient per year; and that there were reductions of about 2.5 episodes of overall hypoglycaemia, 0.5 episodes of nocturnal hypoglycaemia, and 2.1 episodes of daytime hypoglycaemia per patient per year of treatment in BEGIN Basal-Bolus Type 2; and reductions of 0.14 episodes of nocturnal hypoglycaemia in BEGIN Once Long (Type 2). However, it was noted that Degludec is also available in 100unit/ml strength which introduces risk; that clinical trials had shown similar numbers of patients reporting injection site reactions with Degludec as with Lantus, despite smaller injection volume with Degludec 200unit/ml; and that EPAR had highlighted that clinical data was unable to confirm if lower pharmacodynamic variability translates into more stable glucose profiles in clinical practice. On balance, it was agreed that only the high strength degludec would be included on the formulary with the specific criteria for use being reducing incidents of hypoglycaemia, reducing hospital admissions and reduced HbA1C. The formulary entry must state that the high strength insulin is for self-administration only, to prevent misguided attempts by health care professionals to remove insulin from the pen in order to use a safety needle. The CCG pharmacists agreed to ensure their point of prescribing software was updated to alert prescribers that they have selected a high- strength insulin. It was agreed that Toujeo would not be added and Humalog 200 would be removed from the formulary. and MB to feedback to Dr Vaks. PC/RH /MB It was noted that a trial making a direct comparison of Toujeo and high strength Degludec is due to be published in the autumn and this decision will be reviewed when the trial is published. T:\Pharmacy\3 T's Formulary\FWG Meetings\FWG Minutes\Mins_2017\FWG_Minutes_19 January 2017.Doc Page 2 of 5

3 Wiltshire Blood Glucose Monitoring Guidance This guidance is specific to Wiltshire CCG, but it was agreed that it should be published on the 3Ts formulary website. Swindon CCG also has specific guidance which should also be published on the 3Ts website. Esmya for uterine fibroids The Devon guidance, and the suggestion that in menopausal patients Esmya could potentially spare surgery, was noted. Wiltshire are reviewing their commissioning policy and the formulary status of Esmya may need to be reviewed as a result. to advise GWH Gynaecology team of current formulary status of Esmya. Drugs affecting QTc interval The BMJ paper on QT interval and drug therapy was discussed and it was agreed the list of drugs along with advice on how to minimise the risks of these drugs in clinical practice should be summarised as a separated piece of guidance. PC/ PC 5 NEW DRUG Update UKMI New Drugs Online Newsletters for November 2016 & December 2016 were noted. to approach GWH gastroenterology team about developing mab treatment pathway New Drug Requests Fosfomycin IV infusion. It was agreed to add this formulation to the formulary as a red drug for use on microbiological advice only. Modulen IBD This was not added to the formulary. The group felt that the case for use in adults and maintenance therapy was not made. Also, that given that the supplement is used so infrequently and for limited courses, a better alternative would be for the tertiary care centre to prescribe for the entire course. /PC to feedback. NICE NICE TAs TA 427 Pomalidomide for multiple myeloma previously treated with lenalidomide and Bortezomib TA 428 Pembrolizumab for treating PDL1-positive non-small-cell lung cancer after chemotherapy TA 421 Everolimus with exemestane for treating advanced breast cancer after endocrine therapy TA 422 Crizotinib for previously treated anaplastic lymphoma kinasepositive advanced non-small-cell lung cancer /PC T:\Pharmacy\3 T's Formulary\FWG Meetings\FWG Minutes\Mins_2017\FWG_Minutes_19 January 2017.Doc Page 3 of 5

4 TA 423 Eribulin for treating locally advanced or metastatic breast cancer after 2 or more chemotherapy regimens TA 424 Pertuzumab for the neoadjuvant treatment of HER2-positive breast cancer TA 425 Dasatinib, nilotinib and high-dose imatinib for treating imatinibresistant or intolerant chronic myeloid leukaemia Commissioned by NHS England & covered by TVCN TA 426 Dasatinib, nilotinib and imatinib for untreated chronic myeloid leukaemia TA 420 Ticagrelor for preventing atherothrombotic events after myocardial infarction This will have a significant impact on primary care prescribing, and the existing antiplatelet guidance will need updating to reflect the guidance. It was agreed to invite a cardiologist discuss this guidance at the next meeting. TA 288 Dapagliflozin in combination therapy for treating type 2 diabetes The formulary will be updated to reflect this guidance. TA 417 Nivolumab for previously treated advanced renal cell carcinoma TA 418 Dapagliflozin in triple therapy for treating type 2 diabetes The formulary will be updated to reflect this guidance. TA 410 Apremilast for treating moderate to severe plaque psoriasis The formulary will be updated to reflect this guidance. It was noted that any patient taking the drug currently funded by the drug company would need to continue with this funding route unless they comply with the conditions laid out in the TA. 8 MHRA Drug Safety Updates November & December 2016 These were noted. Links will be made to the relevant formulary drugs AOB Braltus Zonda. It was agreed this would be added to the formulary and that the suggestions from the respiratory consultants around the capsule colour and possible taste on inhalation would be included in any primary care switch letters. The COPD guidance will also be updated to reflect this. HIV Drugs. tabled two additional HIV drugs that need to be included on the formulary. As these are funded by NHS England the group was happy for these to be added. /RH/ PC T:\Pharmacy\3 T's Formulary\FWG Meetings\FWG Minutes\Mins_2017\FWG_Minutes_19 January 2017.Doc Page 4 of 5

5 Date, time & venue of next FWG Meeting: 2.00pm. 16 th March Radiology Room, Ground Floor, GWH. Future Meetings: Date Start Finish Room Time Time 18/05/ :00 17:00 Seminar Room 1, The Academy, GWH. 20/07/ :00 17:00 Seminar Room 1, The Academy, GWH. 21/09/ :00 17:00 Radiology Room, Ground Floor, GWH. 16/11/ :00 17:00 Seminar Room 1, The Academy, GWH. Agreed as an Accurate Record: Chair: T:\Pharmacy\3 T's Formulary\FWG Meetings\FWG Minutes\Mins_2017\FWG_Minutes_19 January 2017.Doc Page 5 of 5

GREAT WESTERN HOSPITALS NHS FOUNDATION TRUST. Formulary Working Group 2.00pm 20 th September 2018 The ALIS Room, The Academy, GWH

Formulary Working Group 2.00pm 20 th September 2018 The ALIS Room, The Academy, GWH The 3T s Formulary Swindon CCG & Wiltshire CCG Great Western Hospitals NHS Foundation Trust (In collaboration with Avon