Drug Safety update
October 2021: Tofacitinib (Xeljanz▼): new measures to minimise risk of major adverse cardiovascular events and malignancies
August 2020: Baricitinib (Olumiant▼): increased risk of diverticulitis, particularly in patients with risk factors
March 2020: Baricitinib (Olumiant▼): risk of venous thromboembolism
March 2020: Tofacitinib (Xeljanz▼): new measures to minimise risk of venous thromboembolism and of serious and fatal infections
July 2019: Tocilizumab (RoActemra): rare risk of serious liver injury including cases requiring transplantation
May 2019: Tofacitinib (Xeljanz▼): restriction of 10 mg twice-daily dose in patients at high risk of pulmonary embolism while safety review is ongoing
January 2017: Apremilast (Otezla ▼): risk of suicidal thoughts and behaviour
January 2015: Ustekinumab (Stelara): risk of exfoliative dermatitis
April 2014: There is an increased risk of tuberculosis, or reactivation of latent tuberculosis, during treatment with tumour necrosis factor alpha (TNF-alpha) inhibitors. TNF-alpha inhibitors are contraindicated in patients with active tuberculosis or other severe infections
NICE Guidance (See also drug specific guidance below)
TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis, February 2016.
NG65: Spondyloarthritis in over 16s: diagnosis and management, June 2017.
NG100: Rheumatoid arthritis in adults: management, July 2018.
Adalimumab, certolizumab pegol, etanercept, golimumab, and infliximab inhibit the activity of tumour necrosis factor alpha (anti TNF).
Baricitinib selectively and reversibly inhibits the Janus-associated tyrosine kinases JAK-1 and JAK-2. It may be used if disease is severe and treatment with conventional DMARDs is inadequate or if conventional DMARDs and anti-TNF has failed and the patient cannot have rituximab. The manufacturer advises screening for tuberculosis and viral hepatitis before treatment is started.
Infliximab: adequate resuscitation facilities must be available when infliximab is used.
Rituximab is used in the treatment of severe rheumatoid arthritis when the condition has failed to respond adequately to one or more anti-TNF (in combination with methotrexate) or who are intolerant to them. Follow the link for more information.
Note: NICE has not approved the use of anakinra for the treatment of rheumatoid arthritis. All the above drugs require Blue-teq funding form to be completed.
These are for specialist use only and are prescribed according to NICE guidance.