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Home , Aflibercept, Filgotinib

Recommendations from York and Scarborough Medicines Commissioning Committee March 2021 Drug name Indication Recommendation, rationale and place in RAG status Potential full year cost impact CCG commissioned Technology Appraisals 1. TA672: for Brolucizumab is recommended as an option for treating wet Listed as RED Discussed and approved at Feb 2021 MCC meeting. treating wet age-related age-related in adults, only if, in the eye drug macular degeneration to be treated:  the best-corrected visual acuity is between 6/12 and Commissioning: CCG, 6/96 tariff excluded  there is no permanent structural damage to the central fovea  the lesion size is less than or equal to 12 disc areas in greatest linear dimension and  there is recent presumed disease progression (for example, blood vessel growth, as shown by fluorescein angiography, or recent visual acuity changes).

It is recommended only if the company provides brolucizumab according to the commercial arrangement.

If patients and their clinicians consider brolucizumab to be one of a range of suitable treatments, including and , choose the least expensive (taking into account administration costs and commercial arrangements).

Only continue brolucizumab in people who maintain an adequate response to therapy. Criteria for stopping should include persistent deterioration in visual acuity and identification of anatomical changes in the retina that indicate inadequate response to therapy.

2. TA675: Vernakalant for NICE is unable to make a recommendation about the Not listed No cost impact to CCGs as appraisal terminated by the rapid conversion of use in the NHS of vernakalant for the rapid conversion NICE and insufficient evidence to approve use. recent onset atrial of recent onset atrial fibrillation (7 days or less) to sinus fibrillation to sinus rhythm rhythm in adults who have not had surgery. This is (terminated appraisal) because Correvio Ltd did not provide an evidence submission for the appraisal. The company has Commissioning: CCG confirmed that it does not intend to make a submission because it considers there is insufficient evidence.

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3. TA676: for Filgotinib, with , is recommended as an option for RED Note difference in DAS score compared to other JAK treating moderate to treating active in adults whose disease inhibitors used for moderate treatment. severe rheumatoid has responded inadequately to intensive therapy with 2 or arthritis more conventional disease-modifying antirheumatic drugs NICE estimate uptake of 15% of eligible patients by (DMARDs), only if: 2024/25. Commissioning: CCG  disease is moderate or severe (a disease activity score [DAS28] of 3.2 or more) and Filgotinib is the first advanced treatment (e.g. first JAK  the company provides filgotinib according to the inhibitor or biologic) recommended for people who have commercial arrangement. moderate RA. Existing treatments for people who have Filgotinib, with methotrexate, is recommended as an option for moderate RA are generic. treating active rheumatoid arthritis in adults whose disease has responded inadequately to or who cannot have other For people who have severe RA, a number of advanced DMARDs, including at least 1 biological DMARD, only if: treatment options are already recommended and used.  disease is severe (a DAS28 of more than 5.1) and  they cannot have and Expect 20 patients from YFT per year.  the company provides filgotinib according to the commercial arrangement. Will be more costly if used in moderate group over existing DMARDs, but more cost effective than other Filgotinib, with methotrexate, is recommended as an option for JAK inhibitors or biologics in the severe group. treating active rheumatoid arthritis in adults whose disease has responded inadequately to rituximab and at least 1 YFT will audit use in moderate group to provide some biological DMARD, only if: reassurance around use  disease is severe (a DAS28 of more than 5.1) and  the company provides filgotinib according to the A confidential commercial arrangement is in place. commercial arrangement.

Filgotinib can be used as monotherapy when methotrexate is contraindicated or if people cannot tolerate it, when the criteria in sections 1.1, 1.2 or 1.3 are met.

Choose the most appropriate treatment after discussing the advantages and disadvantages of the treatments available with the person having treatment. If more than 1 treatment is suitable, start treatment with the least expensive drug (taking into account administration costs, dose needed and product price per dose). This may vary from person to person because of differences in how the drugs are taken and treatment schedules.

Continue treatment only if there is a moderate response measured using European League Against Rheumatism (EULAR) criteria at 6 months after starting therapy. If this initial response is not maintained at 6 months, stop treatment.

When using the DAS28, healthcare professionals should take into account any physical, psychological, sensory or learning 2

disabilities, or communication difficulties that could affect the responses to the DAS28 and make any adjustments they consider appropriate.

4. TA678: for NICE is unable to make a recommendation about the Listed as RED No cost impact to CCGs as appraisal terminated by treating chronic use in the NHS of omalizumab for treating chronic drug in 3.4.2 NICE and insufficient evidence to approve use. rhinosinusitis with nasal rhinosinusitis with nasal polyps because Novartis (asthma) and polyps (terminated Pharmaceuticals did not provide an evidence 13.5.3 (chronic appraisal) submission. The company has confirmed that it does urticarial) not intend to make a submission for the appraisal Commissioning: CCG because the technology will not be launched in the UK for treating this indication.

5. TA679: Dapagliflozin for Dapagliflozin is recommended as an option for treating Decision The list price of dapagliflozin is £36.59 per 28‑tablet treating chronic heart symptomatic chronic heart failure with reduced ejection deferred to April pack (excluding VAT; BNF online, accessed November failure with reduced fraction in adults, only if it is used as an add-on to 2021 MCC 2020). The annual treatment cost is £476.98. ejection fraction optimised standard care with: meeting to allow  angiotensin-converting enzyme (ACE) inhibitors for guideline to In the absence of dapagliflozin, the uptake of sacubitril Commissioning: CCG or angiotensin‑2 blockers (ARBs), with support use valsartan is expected to increase to 50% by year 5. In beta blockers, and, if tolerated, locally to be the future it is expected that 25% of the eligible mineralocorticoid receptor antagonists (MRAs), produced. population will receive dapagliflozin as an add-on to or optimised  sacubitril valsartan, with beta blockers, and, if standard care with sacubitril valsartan, with beta tolerated, MRAs. blockers, and, if tolerated, MRAs by year 5 and 50% people to receive dapagliflozin as an add-in to Start treatment of symptomatic heart failure with optimised standard care based on ACE inhibitors or reduced ejection fraction with dapagliflozin on the ARBs, with beta blockers, and, if tolerated, MRAs. advice of a heart failure specialist. Monitoring should be done by the most appropriate healthcare professional. Based on the assumptions used for England, this is equivalent to a cost of around £10,000 per 100,000 People whose symptoms continue or worsen on population. optimised doses of standard care based on ACE inhibitors or ARBs can only start sacubitril valsartan NICE estimate that: under the supervision of a specialist with access to a NY CCG = 28 patients on dapagliflozin by Year 5, total multidisciplinary team. So dapagliflozin should only be cost impact £43,271 by Year 5. started on advice from a heart failure specialist in VoY CCG = 24 patients on dapagliflozin by Year 5, total primary, secondary or community care. cost impact £37,309 by Year 5.

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NHSE commissioned Technology Appraisals – for noting 6. TA671: for Mepolizumab, as an add-on therapy, is recommended as an RED as per No cost impact to CCGs as NHS England treating severe option for treating severe refractory eosinophilic asthma, only NICE TA431: for commissioned. if: eosinophilic asthma treating severe it is used for adults who have agreed to and followed the refractory Commissioned by NHS England - treatment may only Commissioning: NHSE optimised standard treatment plan and eosinophilic be prescribed at Sheffield Teaching, Leeds Teaching asthma. and Hull and East Yorkshire Hospitals (but this is under  the blood eosinophil count has been recorded as 300 review May 2017) cells per microlitre or more and the person has had at least 4 exacerbations needing systemic corticosteroids in the previous 12 months, or has had TA671 replaces TA431. continuous oral corticosteroids of at least the equivalent of prednisolone 5 mg per day over the previous 6 months or  the blood eosinophil count has been recorded as 400 cells per microlitre or more and the person has had at least 3 exacerbations needing systemic corticosteroids in the previous 12 months (so they are also eligible for either benralizumab or ).

Mepolizumab is recommended only if the company provides it according to the commercial arrangement.

If mepolizumab, benralizumab or reslizumab are equally suitable, start treatment with the least expensive option (taking into account drug and administration costs).

At 12 months:  stop mepolizumab if the asthma has not responded adequately or  continue mepolizumab if the asthma has responded adequately and assess response each year.

7. TA673: Niraparib for Niraparib is recommended for use within the Cancer Listed as RED No cost impact to CCGs as NHS England maintenance treatment of Drugs Fund as an option for maintenance treatment for drug in 8.1.5 commissioned. advanced ovarian, advanced (FIGO stages 3 and 4) high-grade epithelial fallopian tube and ovarian, fallopian tube or primary peritoneal cancer after peritoneal cancer after response to first-line platinum-based in response to first-line adults. It is recommended only if the conditions in the platinum-based managed access agreement for niraparib are followed. chemotherapy

Commissioning: NHSE

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8. TA674: NICE is unable to make a recommendation about the Listed as RED No cost impact to CCGs as NHSE commissioned and for untreated PD-L1- use in the NHS of pembrolizumab for untreated drug in 8.1.5 appraisal terminated by NICE. positive, locally advanced PD‑L1‑positive, locally advanced or metastatic urothelial or metastatic urothelial cancer when cisplatin is unsuitable. Merck Sharp & cancer when cisplatin is Dohme has confirmed that it does not intend to make a unsuitable (terminated complete evidence submission for the appraisal. This is appraisal) because it does not consider that the new evidence collected when pembrolizumab was in the Cancer Commissioning: NHSE Drugs Fund (NICE's technology appraisal guidance 522) shows that it works well enough in this patient population to be cost effective.

9. TA677: Autologous anti- Treatment with autologous anti-CD19-transduced CD3+ Not listed as not No cost impact to CCGs as NHS England CD19-transduced CD3+ cells is recommended for use within the Cancer Drugs a drug commissioned. cells for treating relapsed Fund as an option for relapsed or refractory mantle cell or refractory mantle cell in adults who have previously had a Bruton's lymphoma (BTK) inhibitor. It is only recommended if the conditions in the managed access agreement for Commissioning: NHSE autologous anti‑CD19‑transduced CD3+ cells treatment are followed

10. HST14: Metreleptin for Metreleptin is recommended, within its marketing For information No cost impact to CCGs as NHS England treating lipodystrophy authorisation, as an option for treating the complications only. commissioned. of leptin deficiency in lipodystrophy for people who are 2 Commissioning: NHSE years and over and have generalised lipodystrophy. A single National Specialist Service for people with lipodystrophy was established in 2011 at Addenbrooke's Metreleptin is recommended as an option for treating Hospital in Cambridge. Treatment with metreleptin is the complications of leptin deficiency in lipodystrophy for currently provided there as part of an early access people who are 12 years and over, have partial programme, under the National Severe lipodystrophy, and do not have adequate metabolic Resistance Service at the hospital. control despite having standard treatments. It is only recommended if they have an HbA1c level above 7.5%, or fasting triglycerides above 5.0 mmol/litre, or both.

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Formulary applications or amendments/pathways/guidelines 11. Prucalopride for Review of Prucalopride on the York formulary as the AMBER SI No cost impact to CCGs expected as reflects current constipation in men product license changed to include men as well as prescribing practice. women in May 2015.

Approved for use in men as well as women following 6 months treatment of at least 2 classes of laxative at maximum tolerated doses, review after 4 week

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