Ciclosporin is occasionally used in the management of severe inflammatory bowel disease (unlicensed). It requires regular |
monitoring and should only be prescribed under the direction of a specialist. Azathioprine is used in the maintenance of |
remission of acute ulcerative colitis and Chron's disease, and also requires regular monitoring (unlicensed). |
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Maintenance and symptomatic treatment of ulcerative colitis and Crohn's disease: |
AMBER Azathioprine tablets 25mg, 50mg (unlicensed for use in IBD) |
AMBER Ciclosporin capsules 10mg, 25mg, 50mg, 100mg (Neoral®) – (unlicensed for use in IBD) |
(specify brand when prescribing) | RED Ciclosporin 50mg/ml concentrate for iv infusion– (unlicensed for use in IBD) |
|
Cytokine modulators |
RED Vedolizumab SC: Treatment of adult patients with moderately to severely active ulcerative colitis or severely active |
Crohn's disease who have had an inadequate response with, lost response to, or were intolerant to |
either conventional therapy or a tumour necrosis factor-alpha (TNFα) antagonist. |
ICB Commissioned |
The patient and/or carer must receive adequate training in subcutaneous injection technique if their specialist determines |
that it is appropriate to self-inject and with medical follow-up as necessary. Suitability of the patient for subcutaneous home |
use should be assessed and patients should be advised to inform their healthcare professional if they experience symptoms |
of an allergic reaction before administering the next dose. Patients should seek immediate medical attention if developing |
symptoms of serious allergic reactions. Also approved in line with NICE TA 329 and NICE TA352 (see below) |
|
NICE guidance for Ulcerative Colitis updated Feb 2015 (TA329) |
Infliximab ( Remicade®, Inflectra® or Remsima®), adalimumab (Humira®) and golimumab (Simponi®) are recommended |
as possible treatments for adults with moderate to severe ulcerative colitis if conventional therapy hasn’t worked or isn’t |
suitable. |
Infliximab is also recommended as a possible treatment for children or young people aged 6–17 years with severe ulcerative |
colitis, if conventional therapy hasn’t worked or isn’t suitable. |
|
Infliximab is a treatment option for acute exacerbation of severely active ulcerative colitis where the patient meets the NICE |
criteria to start a biologic (TA163). |
RED Infliximab ( Remicade®,Inflectra®,Remsima®.) Prescribe by brand |
RED Adalimumab (Amgevita (1st line choice in new patients, Humira®,) NHS England Commissioned |
RED Golimumab (Simponi®) |
|
NICE guidance for treating moderately to severely active ulcerative colitis (TAG342) |
Vedolizumab is recommended as a possible treatment for adults with moderate to severe ulcerative colitis |
RED Vedolizumab (Entyvio®) |
Concentrate for intravenous infusion 300mg vial |
|
NICE guidance for treating moderately to severely active ulcerative colitis (TA547) |
Tofacitinib is recommended, within its marketing authorisation, as an option for treating moderately to severely active |
ulcerative colitis in adults when conventional therapy or a biological agent cannot be tolerated or the disease has responded |
inadequately or lost response to treatment. |
RED Tofacitinib (Xeljanz®) tablets CCG Commissioned - Bluetec form required |
|
NICE guidance for treating moderately to severely active ulcerative colitis (TA633) |
Ustekinumab is recommended as an option for treating moderately to severely active ulcerative colitis in adults when |
conventional therapy or a biological agent cannot be tolerated, or the disease has responded inadequately or lost response |
to treatment, only if: |
° a tumour necrosis factor-alpha inhibitor has failed (that is the disease has responded inadequately or has lost response |
to treatment) or |
° a tumour necrosis factor-alpha inhibitor canot be tolerated or is not suitable, and |
° the company provides ustekinumab at the same price or lower than that agreed with the Commercials Medicines UNIT |
|
RED Ustekinumab (Stelara®) CCG Commissioned - Bluetec form required |
|
NICE guidance for treating moderately to severely active ulcerative colitis TA792 |
Filgotinib is recommended, within its marketing authorisation, as an option for treating moderately to severe active |
ulcerative colitis in adults: |
> when conventional or biological treatment cannot be tolerated, or |
> if the disease has not responded well enough, or has stopped responding to these treatments, and |
> if the company provides filgotinib according to the commercial arrangement |
|
RED Filgotinib tablets 100mg, 200mg (Jyseleca®) |
|
NICE guidance for treating moderately to severely active ulcerative colitis NICE TA856 |
Upadacitinib is recommended, within its marketing authorisation, as an option for treating moderately to severely active |
ulcerative colitis in adults: |
> when conventional or biological treatment cannot be tolerated, or |
> if the condition has not responded well enough or has stopped responding to these treatments, and |
> if the company provides upadictinib according to the commercial arrangement |
ICS Commissioned, Blueteq required |
|
NICE guidance for treating for moderately to severely active Crohn's disease after prior therapy (TA352) |
RED Vedolizumab (Entyvio®) |
Concentrate for intravenous infusion 300mg vial |
|
NICE guidance for treating for moderately to severely active Crohn's disease after previous therapy (NICE TA456) |
RED Ustekinumab (Stelara®) CCG Commissioned |