The Scottish Medicines Consortium (SMC) has issued its monthly advice on newly licensed medicines.
Tirzepatide (Mounjaro®) has been accepted for restricted use for weight management, including weight loss and weight maintenance, as an adjunct to a reduced-calorie diet and increased physical activity in adults. The restriction limits use to adults with BMI ≥30 kg/m2 and at least one weight-related comorbidity. It is noted that a lower BMI may be more appropriate for members of minority ethnic groups known to be at equivalent risk of the consequences of obesity at a lower BMI than the white population. NICE guidance is expected to be published on October, and it is expected that specialist weight management services would be responsible for providing this medication for this indication.
Last month, budesonide/formoterol (Symbicort®) was accepted for restricted use as a reliever therapy for adults and adolescents (12 years and older) with mild asthma. The restriction limits use to for use in patients who would otherwise receive low dose inhaled corticosteroid (ICS) maintenance therapy plus short-acting beta-2 adrenoceptor agonist (SABA) as needed.
Action: Clinicians should be aware of the recommendations of the SMC. Routine use of rejected and restricted medicines should be avoided.
During May 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 Hearing loss in adults topic has been restructured to improve clarity and navigation. The contraindications, cautions, adverse effects, and drug interactions of angiotensin-converting enzyme inhibitors and beta-blockers in the MI - secondary prevention topic have been replaced with links to relevant sections in the CKS topic on Hypertension. The Peripheral arterial disease topic contains a terminology update; 'critical limb ischaemia' has been replaced with 'chronic limb-threatening ischaemia' in line with the current literature. The Sleep disorders - shift work and jet lag topic has a new section on risk factors and diagnosis.
Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice.
The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for May 2024 (PDF).
This issue advises clinicians that in the coming months topical steroids will start to be labelled with potency information to assist with counselling patients with the aim of reducing the risk of developing topical steroid withdrawal reactions. The risk of such reactions increases with prolonged use and increased steroid potency. It is also recommended that when prescribing or dispensing topical steroids, clinicians should advise on the amount of product to apply, how often, where to apply it and when to stop treatment. Fingertip Units can be a convenient way to advise and measure an appropriate amount of product to apply.
This issue also contains a summary of letters to healthcare professionals in April. These generally related to supply issues and recalls. One letter raises awareness of the discontinuation of Levemir and Insulatard Innolet devices and several needles in the range from the same manufacturer.
Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.
The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of May 2024. This month there are two guidelines that impact upon primary care.
The COVID-19 rapid guideline: managing COVID-19 guideline has been updated. It covers managing COVID-19 in babies, children, young people and adults in community and hospital settings. The update includes revised guidance and new recommendations on the use of anti-vial treatments for COVID-19.
The Atogepant for preventing migraine guideline has been published. It recommends this treatment as an option for preventing migraine in adults who have at least 4 migraine days per month, only if at least 3 preventive medicines have failed. It is further advised that treatment is stopped after 12 weeks if the frequency of migraine does not reduce by 50% in the case of episodic migraine or 30% in the case of chronic migraine. This treatment is reviewed in comparison to monoclonal antibody treatments and botulinum toxin type A and as such recommendation and treatment initiation would be supervised by a specialist.
Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.
During April 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 Axial spondyloarthritis topic has been renamed from "Ankylosing spondylitis" in line with current terminology, recommendations have been updated in line with current evidence and a new Assessment section has been added. The Hypercholesterolaemia - familial topic has a new section describing important risk factors and the prescribing information now includes bempedoic acid and inclisiran. The Insomnia topic now incorporates NICE recommendations on the use of Sleepio and daridorexant in the management of insomnia.
Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice.
