Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

CKS Updates - June 2020

During June 2020 Clinical Knowledge Summaries were published or updated in the following areas.

All of the topics have been reviewed and undergone minor restructuring. The Vitiligo topic has been significantly restructured and recommendations have been updated in line with current evidence; several areas have been moved in line with CKS layout and the Prescribing information section now directs readers to the CKS topic on Corticosteroids - topical (skin), nose, and eyes.

Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice.

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NICE Guidance - June 2020

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of June 2020. This month is one guideline, one medtech innovation briefing and one evidence summary related to COVID-19 that impact upon primary care.

The Joint replacement (primary): hip, knee and shoulder guideline has been published. It covers care before, during and after a planned knee, hip or shoulder replacement. It includes recommendations to ensure that people are given full information about their options for surgery, including anaesthesia. It offers advice for healthcare professionals on surgical procedures and ensuring safety during operations. It also offers guidance on providing support and rehabilitation before and after surgery.

The FibroScan for assessing liver fibrosis and cirrhosis in primary care medtech innovation briefing has been published. This briefing notes that the intended place in therapy would be in primary care for people with liver fibrosis or cirrhosis and recognises that the technology is already used extensively in specialised care settings. It is also noted that it is unclear if every primary care centre would be able to support a FibroScan clinic.

The COVID-19 rapid evidence summary: vitamin D for COVID-19 evidence summary has been published. It notes that there is no evidence to support taking vitamin D supplements to specifically prevent or treat COVID‑19. However, it is also noted the everyone should continue to follow UK Government advice on daily vitamin D supplementation to maintain bone and muscle health during the COVID‑19 pandemic.

Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.

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CKS Updates - May 2020

During May 2020 Clinical Knowledge Summaries were published or updated in the following areas.

All of the topics have been reviewed and undergone minor restructuring. The Sprains and strains topic has been restructured and recommendations have been updated in line with current evidence; the prognosis and complications section has been split and the referral and prescribing sections have been moved into the Management section.

Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice.

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SMC response to COVID-19

The Scottish Medicines Consortium has provided an update advising of the decision to adapt their normal ways of working.

Meetings have been suspended until further notice in order to release committee members and staff to support work aligned with COVID-19 resilience. A core team will continue to assess the new medicine submissions already in the system and work on urgent activities around COVID-19 as required.

The submissions that would have been evaluated during this period have been reviewed and the SMC is satisfied that other medicines are available for the relevant patient groups. At this time new submissions or resubmissions are not being accepted. Meetings will resume when allowed by the COVID-19 restrictions.

Action: Clinicians should be aware that, for the time being, the SMC will not be publishing monthly advice for medicines.

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NICE Guidance - May 2020

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of May 2020. This month there are four rapid guideline and evidence reviews and two evidence summaries related to COVID-19 that impact upon primary care.

The COVID-19 rapid guideline: rheumatological autoimmune, inflammatory and metabolic bone disorders guideline has been updated. The update highlights factors to take into account when considering temporarily stopping some drugs for children and young people.

The COVID-19 rapid guideline: children and young people who are immunocompromised guideline has been published and updated. It aims to maximise the safety of children and young people who are immunocompromised during the COVID-19 pandemic. It also aims to protect staff from infection and enable services to make the best use of NHS resources. The update highlighted that immunosuppressant medicines should be reviewed if a patient may have COVID-19 or there are other medical concerns.

The COVID-19 rapid guideline: chronic kidney disease guideline has been published. It to maximise the safety of adults with chronic kidney disease during the COVID-19 pandemic. It also aims to protect staff from infection and enable services to make the best use of NHS resources.

The COVID-19 rapid guideline: interstitial lung disease guideline has been published. It aims to maximise the safety of adults with interstitial lung disease, including idiopathic pulmonary fibrosis and pulmonary sarcoidosis, during the COVID-19 pandemic. It also aims to protect staff from infection and enable services to make the best use of NHS resources.

The COVID-19 rapid evidence summary: angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in people with or at risk of COVID-19 evidence summary has been published. It aims to determine whether up regulation of angiotensin-converting enzyme 2, potentially as a result of taking ACEIs or ARBs, is associated with an increased risk of developing COVID-19 or developing more severe symptoms. This analysis found two observational studies that were of poor quality and subject to bias and confounding. As such conclusions cannot be drawn without further research.

The COVID-19 rapid evidence summary: Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) for people with or at risk of COVID-19 evidence summary has been published. It aims to determine if long term use of NSAIDs is associated with an increased risk of developing COVID-19 or developing more severe symptoms. A literature search identified no evidence from published scientific studies. However, it is noted that NSAIDs and COVID-19 can both contribute to respiratory, cardiovascular and renal complications.

Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.

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