Injection

• Approved in accordance with NICE TA146 for the treatment of plaque psoriasis
• Approved in accordance with NICE TA455 for the treatment of plaque psoriasis in children and young people
• Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
• Biosimilar Imraldi^® is the first line option for new patients. Biosimilar Amgevita^® can be used second line in those who are unable to tolerate Imraldi^®

Tablets

• Approved in accordance with TA419 for treating moderate to severe plaque psoriasis.
• Approved in accordance with TA433 Apremilast for treating active psoriatic arthritis.

Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

Tablets

• Psoriasis and severe refractory eczema [unlicensed indication]
• Cytotoxic - do not crush tablets.
• Oral suspension (expensive) available as an unlicensed special - recommended strength is 50mg/5mL as per RCPCH guidance. SFH only:send patients to SFH pharmacy for supply

Capsules 25mg, 50mg & 100mg (Neoral^® or Capimune^®), Oral Solution 100mg in 1mL (Neoral^®), Infusion (Sandimmun^®).

• Capimune^® is preferred brand for new patients at SFH. For advice on switching see BNF. 
• MHRA advise prescribe by brand
• Neoral liquid is equivalent to Neoral capsules. If changing from any other preparation contact Medicines Information for assistance.

Injection - Pre-filled syringe

Available at Nottingham NHS Treatment Centre and SFH:

• Approved in accordance with NICE TA534, for treating moderate to severe atopic dermatitis.

Available at NUH only:

• Approved for adolescent patients between 12 and 18 years of age with severe atopic dermatitis for whom the available systemic therapies are not suitable in accordance with Blueteq criteria.

Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

Injection

Approved in accordance with NICE TA521 for treating moderate to severe plaque psoriasis

Tablets

For use in line with SCP below:

Tablets (2.5mg only)

• Methotrexate is available as 2.5mg and 10mg tablets. This is a potential cause of confusion and has led to patients taking accidental overdoses.
  To avoid this only 2.5mg tablets should be prescribed and specified on the prescription
• Amber 1 (shared care) - Patients with severe psoriasis or eczema unresponsive to conventional therapy, when used ONCE weekly in line with Shared Care Protocol (see below). Twice weekly dosing (for any indication) is classified red.
• NUH: Metoject® injection available for paediatric patients - routinely supplied via homecare (prescribe by brand and generic name)

Injection

• Approved in line with NICE TA350 for moderate to severe plaque psoriasis.
• Approved in line with NICE TA407 for active ankylosing spondylitis after treatment with non-steroidal anti-inflammatory drugs or TNF-alpha inhibitors.
• Nottingham NHS Treatment Centre: Approved in accordance with NICE TA445 for treating active psoriatic arthritis after inadequate response to DMARDs

Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information

Ointment 0.03%
Ointment 0.1%

• Moderate to severe eczema. Specialist initiation only. Follow NICE guidance.
• Facial psoriasis - specialist recommendation after initial treatment in primary care as per the APC Psoriasis guideline.

Injection

Approved at Nottingham NHS Treatment Centre and SFH:

• in accordance with NICE TA575 for treating moderate to severe plaque psoriasis.

Injection

• SFH: IV infusions for Crohn's patients are prepared in Aseptic Dispensing Unit. Refer to SPC for pharmacist clinical check.(ONLY first dose IV infusion, remainder: SC syringes organised via Healthcare at Home.)
• Specialist use only for the treatment of adults with moderate to severe psoriasis, in accordance with TA180. Patients who have a sub therapeutic response to ustekinumab at a 45mg dosing and who are over 90kg may be dose escalated to a 90mg dose (nb: an unlicensed dose) as per consultant decision and BAD guidance.
• Specialist use only for the treatment of children over 12 years old with moderate to severe psoriasis (as per licence and commissioning approval), in accordance with TA180.
• Specialist use only, alone or with methotrexate, for the treatment of adults with active psoriatic arthritis when treatment with a TNF alpha inhibitor is contra-indicated but would otherwise be used or one or more TNF inhibitor has been used, in accordance with TA340.
• NUH approved for treating plaque psoriasis in children and young people, in accordance with TA455.
• NUH and Nottinghamshire Treatment Centre approved for treating adults with moderately to severely active Crohn’s disease after previous treatment, in accordance with TA456. Also approved at NUH for paediatric patients >12 years of age when in line with NHS England/Blueteq criteria.
• NUH and Nottingham NHS Treatment centre approved for treating adults with moderately to severely active ulcerative colitis, in accordance with TA633.
• Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information.