ADALIMUMAB

Therapy notes

Amgevita brand first-line
Humira second-line.

For NHS Highland Rheumatology Department GP and Patient information click here (NHSH intranet access required)

Formulation and dosage details

Formulation:

Solution for injection, pre-filled syringe (Amgevita) 20mg/0·4mL, 40mg/0·8mL (hospital use only)


Dosage:

Refer to Department of Rheumatology GP information leaflet for adalimumab.
Homecare is the preferred option - contact nhsh.homecare@nhs.scot

Formulation and dosage details

Formulation:

Solution for injection, pre-filled syringe (Humira) 40mg/0·4mL (hospital use only)

Dosage:

Refer to Department of Rheumatology GP information leaflet for adalimumab.
Homecare is the preferred option - contact nhsh.homecare@nhs.scot

Formulation and dosage details

Formulation:

Solution for injection, pre-filled pen (Amgevita) 40mg/0·8mL (hospital use only)

Dosage:

Refer to Department of Rheumatology GP information leaflet for adalimumab.
Homecare is the preferred option - contact nhsh.homecare@nhs.scot

Formulation and dosage details

Formulation:

Solution for injection, pre-filled pen (Humira) 40mg/0·4mL (hospital use only)

Dosage:

Refer to Department of Rheumatology GP information leaflet for adalimumab.
Homecare is the preferred option - contact nhsh.homecare@nhs.scot

BARICITINIB

Therapy notes

MHRA advice: Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality (April 2023) (www.gov.uk).
MHRA advice: Baricitinib (Olumiant) - risk of venous thromboembolism (March 2020) (www.gov.uk).
MHRA advice: Baricitinib (Olumiant): increased risk of diverticulitis, particularly in patients with risk factors (August 2020) (www.gov.uk).

For NHS Highland Rheumatology Department GP and Patient information click here (NHSH intranet access required)

Formulation and dosage details

Formulation:

Tablets (Olumiant®) 2mg, 4mg

Dosage:

Refer to Department of Rheumatology GP information leaflet for baricitinib.
Homecare is the preferred option - contact nhsh.homecare@nhs.scot

BIMEKIZUMAB

Therapy notes

Formulation and dosage details

Formulation:

Solution for injection in pre-filled syringe and pre-filled pen (Restricted: hospital use only)

Dosage:

Indication: 

  • SMC2605: Alone or in combination with methotrexate, for the treatment of active psoriatic arthritis in adults who have had an inadequate response or who have been intolerant to one or more disease-modifying anti-rheumatic drugs (DMARDs).
    SMC restriction: use in patients with active psoriatic arthritis who have not responded adequately to two conventional DMARDs, given either alone or in combination.

Place in therapy:

  • For those with psoriatic arthritis for whom anti-TNF is not appropriate. Secukinumab 150mg weekly, if poor response escalate to 300mg or alternatively switch to bimekizumab.

Notes:

Homecare is the preferred option - contact nhsh.homecare@nhs.scot

CERTOLIZUMAB PEGOL

Therapy notes

Formulation and dosage details

Formulation:

Solution for injection, pre-filled syringe 200mg/mL (s)

Dosage:

Homecare is the preferred option - contact nhsh.homecare@nhs.scot

ETANERCEPT

Therapy notes

For NHS Highland Rheumatology Department GP and Patient information click here (NHSH intranet access required)

Formulation and dosage details

Formulation:

Solution for injection (Enbrel®) 25mg vial (s)

Dosage:

Prescribe etanercept by brand name.
Refer to Department of Rheumatology GP information leaflet for etanercept.
Homecare is the preferred option - contact nhsh.homecare@nhs.scot

Formulation and dosage details

Formulation:

Pre-filled syringe (Enbrel®, Benepali®) 25mg, 50mg (s)

Dosage:

Prescribe etanercept by brand name.
Refer to Department of Rheumatology GP information leaflet for etanercept.
Homecare is the preferred option - contact nhsh.homecare@nhs.scot

Formulation and dosage details

Formulation:

Pre-filled pen (Enbrel®) 25mg, (Enbrel®, Benepali®) 50mg (s)

Dosage:

Prescribe etanercept by brand name.
Refer to Department of Rheumatology GP information leaflet for etanercept.
Homecare is the preferred option - contact nhsh.homecare@nhs.scot

FILGOTINIB

Therapy notes

MHRA advice: Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality (April 2023) (www.gov.uk).


Risk minimisation materials

For NHS Highland Rheumatology Department GP and Patient information click here (NHSH intranet access required)

Formulation and dosage details

Formulation:

Film-coated tablets 100mg, 200mg (under specialist direction only)

Dosage:

See SMC advice 2365.
Homecare is the preferred option - contact nhsh.homecare@nhs.scot

GUSELKUMAB

Therapy notes

Formulation and dosage details

Formulation:

Solution for injection in pre-filled pen (Tremfya®) 100mg 

Dosage:

100mg by subcutaneous injection at weeks 0 and 4, followed by a maintenance dose every 8 weeks.
For patients at high risk for joint damage according to clinical judgement, a dose of 100 mg every 4 weeks may be considered.
Consideration should be given to discontinuing treatment in patients who have shown no response after 24 weeks of treatment.
See SMC advice 2360.

Formulation and dosage details

Formulation:

Solution for injection in pre-filled syringe (Tremfya®) 100mg 

Dosage:

100mg by subcutaneous injection at weeks 0 and 4, followed by a maintenance dose every 8 weeks.
For patients at high risk for joint damage according to clinical judgement, a dose of 100 mg every 4 weeks may be considered.
Consideration should be given to discontinuing treatment in patients who have shown no response after 24 weeks of treatment.
See SMC advice 2360.

Notes:

Guselkumab is intended for use under the guidance and supervision of a physician experienced in the diagnosis and treatment of psoriatic arthritis.
See Summary of Product Characteristics (SPC) for more details.

INFLIXIMAB

Therapy notes

  • Prescribe infliximab by brand name.

For NHS Highland Rheumatology Department GP and Patient information click here (NHSH intranet access required)

Formulation and dosage details

Formulation:

Powder for concentrate for solution for infusion (Inflectra®, Remsima®, Zessly®) 100mg (s)

RITUXIMAB

Therapy notes

For NHS Highland Rheumatology Department GP and Patient information click here (NHSH intranet access required)

Formulation and dosage details

Formulation:

Concentrate for solution for infusion (Truxima®) 100mg/10mL, 500mg/50mL (s)

Dosage:

Prescribe rituximab by brand name.
Refer to Department of Rheumatology GP Information Leaflet for rituximab.

SARILUMAB

Therapy notes

For NHS Highland Rheumatology Department GP and Patient information click here (NHSH intranet access required)

Formulation and dosage details

Formulation:

Solution for injection, pre-filled syringe 150mg, 200mg (specialist use only)

Dosage:

Refer to Department of Rheumatology GP information leaflet for sarilumab (Kevzara®).
Homecare is the preferred option - contact nhsh.homecare@nhs.scot

Formulation and dosage details

Formulation:

Solution for injection, pre-filled pen 150mg, 200mg (s)

Dosage:

Refer to Department of Rheumatology GP information leaflet for sarilumab (Kevzara®).
Homecare is the preferred option - contact nhsh.homecare@nhs.scot

SECUKINUMAB

Therapy notes

  • For NHS Highland Rheumatology Department GP and Patient information click here (NHSH intranet access required)

Formulation and dosage details

Formulation:

Solution for injection, pre-filled syringe 150mg (Hospital use only)

Dosage:

Place in therapy for psoriatic arthritis: 

  • For those with psoriatic arthritis for whom anti-TNF is not appropriate. Secukinumab 150mg weekly, if poor response escalate to 300mg or alternatively switch to bimekizumab.

Homecare is the preferred option - contact nhsh.homecare@nhs.scot

TOCILIZUMAB

Therapy notes

MHRA advice: Tocilizumab (RoActemra): rare risk of serious liver injury including cases requiring transplantation (July 2019) (www.gov.uk).

For NHS Highland Rheumatology Department GP and Patient information click here (NHSH intranet access required)

Formulation and dosage details

Formulation:

Concentrate for solution for intravenous infusion 80mg/4mL, 200mg/10mL, 400mg/20mL (s)

Dosage:

Refer to Department of Rheumatology GP information leaflet for subcutaneous tocilizumab.
Homecare is the preferred option - contact nhsh.homecare@nhs.scot

Formulation and dosage details

Formulation:

Solution for injection, pre-filled syringe 162mg/0·9mL (s)

Dosage:

Refer to Department of Rheumatology GP information leaflet for subcutaneous tocilizumab.
Homecare is the preferred option - contact nhsh.homecare@nhs.scot

TOFACITINIB

Therapy notes

MHRA advice: Tofacitinib (Xeljanz): new measures to minimise risk of major adverse cardiovascular events and malignancies (October 2021) (www.gov.uk).
MHRA advice: Tofacitinib (Xeljanz) - new measures to minimise risk of venous thromboembolism and of serious and fatal infections (March 2020) (www.gov.uk).
MHRA advice: Tofacitinib (Xeljanz) - restriction of 10mg twice-daily dose in patients at high risk of pulmonary embolism while safety review is ongoing  (May 2019) (www.gov.uk).

For NHS Highland Rheumatology Department GP and Patient information click here (NHSH intranet access required)

Formulation and dosage details

Formulation:

Tablets 5mg (s)

Dosage:

Refer to Department of Rheumatology GP information leaflet for tofacitinib (Xeljanz®).
Homecare is the preferred option - contact nhsh.homecare@nhs.scot

Formulation and dosage details

Formulation:

Modified release tablets 11mg (hospital use only)

Dosage:

Once daily alternative.
Homecare is the preferred option - contact nhsh.homecare@nhs.scot

UPADACITINIB

Therapy notes

For NHS Highland Rheumatology Department GP and Patient information click here (NHSH intranet access required)

Formulation and dosage details

Formulation:

Tablet 15mg prolonged release (specialist initiation only)

Dosage:

See SMC advice 2315 and 2361.

Homecare is the preferred option - contact nhsh.homecare@nhs.scot

Editorial Information

Document Id: F274