The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway.

ULCERATIVE COLITIS

The Surrey Heartlands Integrated Care System Area Prescribing Committee recommends the use of infliximab subcutaneous injection or infliximab intravenous infusion. Clinicians & patients will be able to choose the most appropriate product for them at the point of prescribing.

ULCERATIVE COLITIS

The Area Prescribing Committee recommends infliximab dose escalation (5mg/kg every 6 weeks OR 10mg/kg every 8 weeks) in patients with moderately to severely active ulcerative colitis for a 12 week treatment course to recapture response.

Patients must return to standard dosing (5mg/kg every 8 weeks) after the 12 week course has been completed. 

If the patient loses response to the standard dosing within a short time period   then the provider can apply for funding to return to the escalated dose 

If a patient returns to standard dosing, maintains response for a number of standard doses,  but then subsequently flares the patient will be required to repeat the 12 week course and the appropriate tick box form will need to be completed

Infliximab is a payment by results excluded drug and will be considered RED on the traffic light system.

Gastroenterology specialists will be required to complete blueteq initiation and continuation forms for the commissioners.

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

Please see the attached updated treatment pathway below. All the Inflammatory Bowel Disease pathways (from presenting with symptoms to initiation with a high cost immunosuppressant) can be found here:

https://surreyccg.res-systems.net/pad/Guidelines/Detail/6186

ULCERATIVE COLITIS

The PCN recommends the sequential use of TNF alpha inhibitors (adalimumab, infliximab or golimumab) in patients with moderately to severely active ulcerative colitis prior to a switch to vedolizumab.

Adalimumab, Infliximab and Golimumab are payment by results excluded drugs and will be considered RED on the traffic light system.

Gastroenterology specialists will be required to complete blueteq initiation and continuation forms for the commissioners.

ULCERATIVE COLITIS

The PCN recommend the use of Adalimumab, Golimumab, Infliximab and Vedolizumab in line with NICE guidelines and a treatment pathway has been developed with local gastroenterologists. In May 2015 the PCN also supported the branded prescribing of biosimilar infliximab (Inflectra and Remsima) to be used in new patients for all indications where they have licensing authorisation in the UK.

ULCERATIVE COLITIS

The PCN supports the branded prescribing of biosimilar infliximab (Inflectra and Remsima) to be used in new patients for all indications where they have licensing authorisation in the UK.

The Medicines and Healthcare Products Regulatory Agency (MHRA) recommends to prescribe biological products by brand name to ensure that substitution of a biosimilar product does not occur when the medicine is dispensed by the pharmacist. Https://www/gov/uk/drug-safety-update/biosimilar-products

Primary care prescriber should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.