Dmards Enquiries To: Lesley Coyle Extension: 56525 Direct Line: 01224 556525 Email: Gram [email protected]

NHS Grampian NHS ' 4\f rf

Westholme Grampian Woodend Hospital Queens Road ABERDEEN AB15 6LS

Date: 22/07/2021 Our Ref: FA/COVID19_Guide_DMARDs Enquiries to: Lesley Coyle Extension: 56525 Direct Line: 01224 556525 Email: gram [email protected]

This letter authorises the extended use of the following guideline until April 2022

Disease Modifying Anti-Rheumatic Drugs (DMARDs)

This guideline remains clinically accurate and relevant.

If you have any queries regarding this please do not hesitate to contact the Pharmacy and Medicines Directorate.

Yours sincerely

Lesley Coyle Chair of Medicines Guidelines and Policies Group Disease Modifying Anti-Rheumatic Drugs (DMARDs)

Previous guidelines have recommended different monitoring schedules for individual DMARDs. This has led to confusion in primary and secondary care and for patients. This document highlights agreed consistent monitoring schedules with an overall reduction in DMARD monitoring requirements in primary care. This document is valid for the DMARDs listed, independent of the indication.

This is not valid for renal patients. It is noted that the renal speciality will continue to manage their patients. GP practices are only required to undertake blood monitoring for renal patients in exceptional circumstance.

Monitoring Guidelines Azathioprine, Leflunomide, Methotrexate, Mycophenolate or Sulfasalazine Baseline FBC, creatinine clearance, LFTs and albumin Week 2 Leflunomide: Also BP and weight Week 4 Week 6 Week 10 Change to monthly monitoring as above if stable Week 14 Week 18 Week 30 Change to quarterly monitoring as above if stable Week 42 After week 42: Azathioprine, leflunomide, methotrexate or mycophenolate may be monitored quarterly in stable patients. Sulfasalazine would no longer need to be monitored in stable patients.

Ciclosporin, Tacrolimus, Leflunomide + Methotrexate Combined Baseline FBC, creatinine clearance, LFTs and albumin. Also BP Week 2 Ciclosporin & Tacrolimus: Also glucose Week 4 Leflunomide: Also weight Week 6 Week 10 Change to monthly monitoring as above if stable Week 14 Week 18 Week 22 Week 26 Week 30 Week 34 Week 38 Week 42 Week 46 Week 50 After week 50: Ciclosporin, tacrolimus or leflunomide + methotrexate combined: Quarterly monitoring is appropriate in stable patients.

If there are any patients who require an alternative monitoring schedule to that indicated this will be highlighted on an individual patient basis to the GP Practice.

UNCONTROLLED WHEN PRINTED Review Date: March 2021 Identifier: NHSG/Guide_DMARDs/GADTC1078 - 1 - Disease Modifying Anti-Rheumatic Drugs (DMARDs) – Version 1