Medway Primary Care Trust

Minutes from the Medway and Swale Drugs & Therapeutics Committee

Ultrasound Seminar Room, Level 2 Red Zone

Medway Hospital, Gillingham, Kent, ME7 5NY

Wednesday 18 th February 2015 12:00pm - 14:00pm

1. Members Dr Las Ayathurai (LA) Chair; GP, Swale CCG Louise Dark (LD) Chief Pharmacist, MFT Oni Odelade (OO) Prescribing Advisor, Medway Clinical Commissioning Group (CCG) Bal Minhas (BM) Prescribing Advisor, Swale Clinical Commissioning Group Yvette Bartlett (YB) Associate Chief Pharmacist – Clinical Services, MFT Dr Manpreet Pujara (MP) GP, Medway CCG Dr Zika Petrovic Anaesthetist, Medway Foundation Trust (MFT) Korede Ibitoye (KI) Pharmacist, MCH In attendance Jess Clements HIV Pharmacist, Medway Foundation Trust (MFT) Dr Alastair Stewart Respiratory clinician, Medway Foundation Trust (MFT)

2. Apologies for absence Bukky Francis Richard Patey

3. Matters Arising See action log

4. Minutes of the last meeting held and action points

Parool Darbar has approved hyper acute stroke pathway policy. Minutes approved

Action Log Review

The action log was reviewed – refer to log for updates.

5. Conflict of Interest LD declared she used to work for GSK in 2012/13

6. New Drug Applications / Changes to Current Formulary Status

Anoro and Incruse Ellipta for COPD: Dr Stewart presented the papers on Incruse [Umeclidinium Bromide (LAMA)] and Anoro [Umeclidinium Bromide/ Vilanterol (LAMA/LABA)] - maintenance bronchodilator’s to relieve symptoms in adult patients with COPD A discussion was had about the amount of different

1 inhalers on the market and if more drugs were likely to enter the marketplace soon. Novartis and Boehringer are both likely to introduce new drugs in the future but it was felt this should not prevent discussions and decisions now. Each different device has pros and cons. It was felt that once daily administration was likely to improve adherence. Using the same device throughout a treatment pathway could offer benefits for those patients that used them easily. The Anoro and Incruse Ellipta could offer cost savings to the primary care setting.

For both devices and indications it was agreed that they could only be used for current patients if those patients were not currently controlled or if they could not tolerate their current device.

The expiry of 6 weeks once opened was noted. It was agreed it would be difficult in practice to prescribe one at a time. It was felt that COPD guidelines needed to be finalised.

Decision: Approved both but to ease the amount of options Glycopyronium bromide (Breezehaler) should be removed from the guidelines

Action: BM to email Dr Stewart the proposed COPD guidelines and to be brought back at the March meeting for approval

Tivacay (Dolutegravir) and Triumeq (Dolutegravir/ Abacavir / Lamivudine) for treatment of HIV: Jess Clements presented the 2 applications for use in both treatment naïve and treatment experienced patients. They would be used as an alternative treatment for those treatment naïve patients in whom an NNRTI is not appropriate, or for use in patients requiring a change in treatment due to tolerability, or for use in treatment experienced patients who have recorded treatment failure or resistance requiring treatment with an integrase inhibitor. It was anticipated this would be for low numbers of patients initially as most patients start on an NNRTI BHIVA are expected to review soon. NHSE have approved to use so long as all patients are discussed at a MDT meeting.

Decision: Approved

7. Guidelines/Pathways

DMARDs: As per action log – LD to set up a meeting with medicine

PR2014-12 and briefing note Weight based dosing of biological therapies for the treatment of psoriasis – this was not funded – For information. LD to ensure circulated to MFT clinicians Approved

NR 2014-01 and briefing note: Certolizumab pegol for psoriatic arthritis – this is commissioned as an additional option to the currently available TNF alpha inhibitors recommended by NICE for psoriatic arthritis. LD to ensure circulated to MFT clinicians Approved

8. Formulary Adherence Discussed at regular pharmacist meeting between primary and secondary care

2 9. MHRA Safety Alerts

January 2015 update discussed 10. NICE  NICE TA327 – Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism Decision: MFT have local policy where Dabigatran is not used, Rivaroxaban is on formulary due to safety concerns. This to be reflected on NICE compliance sheet  NICE DG 14 - Atrial fibrillation and heart valve disease: self-monitoring coagulation status using point-of-care coagulometers (the CoaguChek XS system and the INRatio2 PT/INR monitor) – committee felt this was not appropriate to MFT. For the CCG need assurance around patients that are selected. OO / KI to take forward  NICE DG 16 - Fluorouracil chemotherapy: The My5-FU assay for guiding dose adjustment – BF to find out from MTW if Kent region are using / wish to use

12. Any Other Business None

Date of next meeting Wednesday 18th March, 2015 (Ultrasound Seminar Room, Red zone level 2)