The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of August 2024. This month there are two clinical guidelines that impact upon primary care.
The Adrenal insufficiency: identification and management guideline has been published. It covers identifying and managing adrenal insufficiency (hypoadrenalism) in babies, children, young people and adults. It aims to improve the treatment of primary, secondary and tertiary adrenal insufficiency, and the prevention and management of adrenal crisis.
The Diabetic retinopathy: management and monitoring guideline has been published. It covers managing and monitoring diabetic retinopathy in people under the care of hospital eye services. However, there are some recommendations that are of some relevance in primary care. In particular, the beneficial impact on vision of good long-term management of diabetes and changes in vision that can result from rapid reductions in HbA1c.
Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.
The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for August 2024 (PDF).
This issue advises clinicians about a collaboration between the MHRA and Genomics England that aims to improve understanding of how a patient's genetic makeup may increase their risk of experiencing harmful side effects to medicines. It is hoped that specific genetic traits that predispose patients to serious side effects can be identified; in time this could allow pre-treatment screening and improved medicines safety. This pilot stage will investigate severe bleeding events with DOACs and severe skin reactions with allopurinol. Yellow cards already submitted for such reactions, and any future cards submitted may result in the reporter being contacted to encourage participation in this pilot.
Lastly, this issue contains a summary of letters to healthcare professionals in July. These generally related to supply issues and recalls.
Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.
The Scottish Medicines Consortium (SMC) has issued its monthly advice on newly licensed medicines.
Fezolinetant (Veoza®) has been rejected for the treatment of moderate to severe vasomotor symptoms (VMS) associated with menopause. The manufacturer failed to make a submission for this indication.
Action: Clinicians should be aware of the recommendations of the SMC. Routine use of rejected and restricted medicines should be avoided.
During July 2024 Clinical Knowledge Summaries were published or updated in the following areas.
All of the topics have been reviewed and updated with minor structural and layout changes. The Developmental rheumatology in children topic now includes an assessment section and information has been added where GP reassurance may be sufficient with no referral necessary. The GORD in children topic has been amended to improve clarity and navigation, and a link to the First Steps Nutrition Trust resources has been added. The Migraine topic has been updated regarding the recently launched topiramate pregnancy prevention programme with candesartan or sodium valproate included as alternative treatment options. A recommendation to seek specialist advice about anti-emetic use in pregnant and breastfeeding women has been added.
Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice.
