LANARKSHIRE AREA DRUG & THERAPEUTICS COMMITTEE

Minute of the meeting held on Wednesday 11 October 2017 at 10am in Meeting Room 5, Kirklands Hospital

PRESENT: / Mr George Lindsay [Chair]
Mr Bill Angus
Dr Vijay Sonthalia
Mrs Anne Milne
Mrs Mary Gilfillan
Dr Stephanie Dundas
Mrs Gail Richardson
Miss Anne Auld
Dr AAW Majumdar
Miss Katrina Mackie
Mr John Milne
Mrs Christine Gilmour
Dr Malekian present from 11:15am after which we took items 3b, 3c, 7c, 7d, 15d
2017/158 / Apologies
Miss Linda Johnstone, Mrs Karen Patterson
2017/159 / Declaration of interest
There were no notes of interest for the items being discussed today.
2017/160
(a)
(b)
(c)
(d)
(e) / Matters Arising not covered elsewhere on the agenda
Ratification of Minutes of meeting of 13 September 2017
The Minute of this meeting was agreed with the exception that under item 2017/143e, Anticoagulant Guidance for Non-valvular Atrial Fibrillation, the reference to Mr Gilmour should be changed to Mrs Gilmour
The amended minute of 16 August 2017 was approved and can now be posted on the website.
Familial Hyperlipidaemia Guideline [update]
Dr Malekian indicated that he had further discussions with cardiologists and there is a preference for a multidisciplinary group to be re-established to look at this issue. It will focus first of all on familial hyperlipidaemia but will extend to update lipid guidelines in general. Dr Malekian will discuss with the Specialists and encourage them to establish the group which will include Mrs Anne Milne, Mrs Karen Patterson, Dr Vijay Sonthalia.
Terms of Reference for ADTC [update]
This was discussed along with item 7d, see below.
Pathway for Approval of High Cost Medicine [update]
Mrs Gilmour indicated that the paper had been agreed with both Primary Care and Acute Prescription Management Boards and with the PQEB. Mrs Gilmour was taking advice on precisely how it should feed into the Health and Social Care Partnerships.
Development of Regional Adult Therapeutics Handbook
Mrs Gilmour talked about local discussion with Dr Manish Patel and with the Regional Medical Directors. This is an important issue but the forum for taking it forward is in conjunction with the Regional Medical Directors and Mrs Gilmour will arrange this with periodic feedback to the ADTC. There is no need for this item to remain a standing item on the ADTC Agenda. / MMcC
MMcC
MM
CG
CG
2017/161 / SMC NEW Submissions
FULL SUBMISSION
Mercaptamine (Procysbi®) (No. 1272/17)
This was noted.
Olaratumab (Lartruvo®) (No. 1273/17)
This was noted and feedback will come from the West of Scotland Cancer Network.
Glecaprevir / pibrentasvir (Maviret®) (No. 1278/17)
This was noted and will be referred to the Blood Borne Viruses Managed Care Network.
2nd RESUBMISSION
Pegvisomant (Somavert®) (No. 158/05)
This was noted and feedback will come from Endocrinology specialists.
ABBREVIATED SUBMISSION
Midazolam (as maleate) (Epistatus®) (No. 1279/17)
This was noted and feedback will come from Neurology specialists.
Raltegravir (Isentress®) (No. 1280/17)
This was noted and will be referred to the Blood Borne Viruses Managed Care Network.
NON-SUBMISSIONS
Abatacept (Orencia®) (No. 1287/17)
This was noted.
Everolimus (Certican®) (No. 1288/17)
This was noted.
Ibrutinib (Imbruvica®) (No. 1289/17)
This was noted. /
KM
2017/162 / SMC follow-up
Miss Mackie talked the committee through the SMC follow-up which had been previously circulated. For beclometasone dipropionate anhydrous / formoterol fumarate dihydrate / glycopyrronium bromide (Trimbow®) the Respiratory MCN are in the process of reviewing their COPD guidance. This will be submitted to the committee in due course. Trimbow® will be categorised as non-formulary until the guidance is updated. /
KM
2017/163
(a) / NHS Lanarkshire formulary
Stoma product formulary
At the request of stoma nurse specialists additonal items were added to the formulary. The ADTC ratified the amendments. /
KM
2017/164
(a)
(b) / Clinical Protocols
ADHD Update from Working Group
There is no update at this time but Dr Majumdar will continue to liaise with the ADHD Working Group and anticipates reporting back at the November meeting.
Palliative Care S/C Administration by Relatives / AAM
(c)
(d)
(e)
(f)
(g)
(h)
(i) / Miss Johnstone had e-mailed information indicating that we can expect an
update on this issue at the November meeting.
Anticoagulant Guidance in Atrial Fibrillation
There was a fulsome discussion about the paper produced and it was agreed
that it be re-drafted to clarify the importance of creatinine clearance in respect of
choice and dosing of DOAC.
Notwithstanding that it was agreed that both Edoxaban and Apixaban should
be added to the NHS Lanarkshire Joint Formulary with a link to the updated
Guidance on how anticoagulants be used. Entry to the formulary will occur
once the guidance is updated and a link can be inserted.
Guidance on Development of Protocols/Guidelines
This item was taken along with item 3c, ‘Terms of Reference for ADTC.’ It was agreed that the guidance should be updated to clarify the specific niche of medication related protocols to come to the ADTC. Mr Lindsay agreed to incorporate that paragraph.
In addition, it was agreed that from now on we should adopt this guidance for all policy and protocols guidelines coming to the Committee. Dr Malekian indicated that this process had already started and we can anticipate an addiction medicine related protocol coming in the relatively near future which will have used the updated guidance.
Teicoplanin Dosing Regimen
Dr Dundas spoke through the Teicoplanin dosing regimen and reminded us that although some of the use is unlicenced it is readily referenced to best practice and a blanket unlicenced use form had been signed. It was agreed that this document should be approved by the ADTC and can now be implemented.
Baricitinib
There was a useful discussion about this protocol. Dr Sonthalia drew particular attention to the blood monitoring section where is says ‘all blood monitoring including lipid check will be the responsibility of the prescribing hospital physician.’ He commended this statement for its clarity and recommended that where appropriate an analogous statement should be included in all such protocols.
The protocol was agreed by the ADTC. It was noted that under the cost implications section there is reference to confidential data which needs to be removed before the clinical protocol can be placed on a public website. This will be reported back to the rheumatologists by Mrs Richardson
Ixekizumab
There was a useful discussion about this protocol. Similar to the Baricitinib protocol it is important that confidential pricing information is removed before this is published. There was also debate about the availability of a designated Nurse required to monitor drug usage. A statement clarifying that ‘all blood monitoring will be the responsibility of the prescribing hospital physician’ should also be included for clarity. This to be fed back to Dr Gupta by Mrs Patterson.
Revised Antibiotic Policies
Dr Dundas spoke to the suite of revised antibiotic policies and with the exception of minor typographical changes they were all endorsed by the Committee.
Ustekinumab
Mrs Richardson talked through a protocol for ustekinumab. There as general support for the purpose of the protocol albeit certain sections were as yet incomplete. It was agreed that Mrs Richardson would liaise with the gastroenterologists to circulate a completed version with a view to members of the ADTC feeding back comments by Fri 27th Oct. / LJ
MM
KM
GL
SD
GR
KP
SD
GR/ALL
2017/165 / ADTC Bulletin
The ADTC New Medicines Decisions for September 2017 was noted. / KM
2017/166 / Unlicensed Medicines
There was nil to note.
2017/167 / NICE/HIS Guidance
There was nil to note.
2017/168 / Medication and Clinical Risk in Lanarkshire
The recent MHRA statements with regard to Miconazole Oral Gel interactions and the dangers of overdose of Loperamide were noted. ADTC members found this valuable learning and agreed that it should be communicated broadly within NHS Lanarkshire. This to be done by means of prescribing notes. /
AM
2017/169 / Regional Cancer Advisory Network
Mr Milne talked through the extensive work which has recently been undertaken by the West of Scotland Cancer Advisory Network. Everyone commended the quality of this work. /
JM
2017/170 / Patient Safety Alerts
There was nil to note.
2017/171 / Lay Member Related Items
There was nil to note at this meeting albeit Mr Angus indicated that he would like some discussion at the next meeting on issues relating to ‘Realistic Medicine.’
2017/172
(a)
(b)
(c)
(d)
(e)
2017/173 / Correspondence
ADTC Collaborative
Mrs Gilmour discussed the webex which had taken place on Tuesday 12 October. The key point was the aspiration for the Single National Formulary to be established by September 2019. In addition,
The withdrawal of the EAMS Scheme for Dupilumab was noted
The correspondence regarding PACS Tier 2 roll out was noted
Clexane Shortage [update]
Mr Lindsay discussed the communications to GPs and Community Pharmacists and the feedback from Lloyds that while there was a substantial availability of the Inhixa Brand from their wholesaler it would only be used to dispense against prescriptions which were clearly written for the Inhixa Brand.
At this stage there is no anticipation that NHS Lanarkshire will need to move over the Inhixa Brand but the situation will be kept under review.
Valproate Safety
There was a good discussion about the issues relating to Valproate safety. It was agreed that the prescribing management team technicians could facilitate GPs by carrying out a search for all women under the age of 55 who are receiving Valproate and this information could be presented to GPs. In addition, when this search has been carried out the technicians could ensure that all such patients who have Valproate on repeat medication system have their repeats scheduled so that there must be a 12 monthly review of the repeat requirements. As well as having an advantage in itself this will also ensure that the valuable ScriptSwitch® message reminding prescribers of the issues relating to Valproate use in women of childbearing age is flagged up to prescribers.
In addition, it was agreed that a letter be sent to GP practices, community pharmacy superintendents, hospital pharmacies and specialists within the managed service albeit the letters should be modified to focus primarily on the actions which each of the professions is expected to take.
YCC Scotland Annual Report and Local Report
Mrs Gilmour discussed the report which suggested that NHS Lanarkshire was a relatively low user of the Yellow Card reporting systems. It was discussed that the four page summary was a useful document and it could usefully be communicated to all professions within NHS Lanarkshire. Mrs Gilmour will arrange for this to happen via the managed service. Mr Lindsay will arrange for this to happen to the contracted service and Mrs Milne will reiterate the messages via a special edition of prescribing notes.
AOCB
There were no additional items. / CG
KP/GL
GL
AA
GL
CG
GL
AM
2017/174 / Date of Next Meeting
Wednesday 15 November 2017, 10am, The Boardroom, Kirklands Hospital.

4