LANARKSHIRE AREA DRUGS & THERAPEUTICS COMMITTEE



LANARKSHIRE AREA DRUG & THERAPEUTICS COMMITTEE

Minute of the meeting held on Wednesday 21 June 2017 at 10am in the Board Room, Kirklands

|PRESENT: |Dr Mehrdad Malekian [Chair] | |

| |Mrs Anne Milne |Mr John Milne |

| |Dr Stephanie Dundas |Dr AAW Majumdar |

| |Mr George Lindsay |Mr Bill Angus |

| |Mrs Gail Richardson |Dr Vijay Sonthalia |

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|2017/087 |Apologies | |

| |Miss Anne Auld, Mrs Christine Gilmour, Miss Linda Johnstone, Mrs Karen Patterson, Miss Katrina Mackie | |

|2017/088 |Declaration of interest | |

| |Doctor Malekian reminded everyone of the importance of stating any declaration of interest for today’s meeting. There were | |

| |no notes of interest declared. | |

|2017/089 |Matters Arising not covered elsewhere on the agenda | |

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|(a) |The revised minute of 19 April 2017 was reviewed and agreed as a true record of the meeting. This can now be published on | |

| |the Website. |MM |

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| |The minute of 24 May 2017 was reviewed and agreed as a true record of the meeting. This can now be published on the | |

| |Website. |MM |

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|(b) |Familial Hyperlipidaemia and Entresto Guidelines | |

| |Doctor Malekian introduced these guidelines. There was very useful debate covering the following issues: | |

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| |Dr Sonthalia indicated that MABs had never yet been prescribed by GPs so this would be a change in Policy. It was discussed| |

| |however that MABs cover a range of treatments and our experience with them is growing and the fact that that no MABs have | |

| |yet been prescribed by GPs does not mean in itself that MABs should not be prescribed by GPs. | |

| | | |

| |Ezetimibe is part of this guideline and this may cause confusion because there is a feeling that previous prescribing | |

| |policies removed ezetimibe from recommendations. The context, however, is that this is a guideline specifically for | |

| |familial hyperlipidaemia and ezetimibe does have a niche for this indication. | |

| | | |

| |The guideline is based upon a Glasgow Shared Care Agreement and there is not a Shared Care Agreement yet in Lanarkshire so | |

| |references to that should be removed. The guideline on its own even without a complementary Share Care Agreement is a very| |

| |useful statement of the expectation of all stakeholders. | |

| | | |

| |The outcome of the discussion was that a next draft of the guideline be recommended to include numbers of patients, funding,| |

| |an option appraisal of the different Pharmacy supply routes including managed service, home care and contracted service | |

| |supply along with associated costs. To help with this Mrs Richardson will liaise with Helen Barclay within Pharmacy at | |

| |Wishaw General and Karen Patterson, Head of Pharmacy at Hairmyres Hospital and indicate that Dr Vickers will likely be in | |

| |touch with both of them. | |

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| |Terms of Reference for ADTC | |

| |A further proof read for consistency of statement is required and Mr Lindsay indicated that he would undertake this. Any | |

| |other comments to be received by end June and the anticipation is that the Terms of Reference will be finalised at the next | |

| |meeting of the ADTC. | |

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| |Guidance on Production of Guidelines | |

| |Doctor Malekian talked through useful feedback he had received from Dr Iain Wallace and the PQEB with regards to a |GR |

| |Declaration of Interest. An amendment to the document incorporating these amendments will be made and circulated. In | |

| |addition, we need guidance on the threshold for onward referral should any new Guidelines present a significant financial | |

| |challenge. This could be either for one patient with a large cost of treatment per patient or for treatments which may have| |

|(c) |a low cost of treatment per patient but have many patients treated in a year. Doctor Malekian will write to Derek Yuille | |

| |and Fiona Porter for their advice on thresholds which would require referral. |GL |

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| |It is also realised that within NHS Lanarkshire an overall Executive Group to look at financial decisions may be required | |

| |although the precise details of how this will be worked are not yet clear. | |

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|(d) |It is also anticipated that this document will be finalised at the next meeting of the ADTC. | |

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| |ADHD Protocols | |

| |Mr Lindsay indicated that he had contacted Mrs Dewar giving feedback from the last ADTC. Mrs Dewar is currently on holiday | |

| |but we will provide a response for the next meeting of the ADTC. | |

| | | |

| |GP Adult Empirical Treatment of Infection Guidelines | |

| |Doctor Dundas talked through the modifications based on feedback at the May Meeting and these Guidelines are now ready for | |

| |dissemination which will be organised by the Area Antimicrobial Management Team. | |

| | | |

| |Anticoagulant Guidance for Non-valvular Atrial Fibrillation | |

| |Doctor Majumdar indicated that he has been in discussion with Dr Iain Wallace and a Working Group about this. He also | |

| |indicated that we expect National Guidance on this in the next few weeks and that will inform the Lanarkshire decision. If | |

| |for any reason the national decision is delayed Lanarkshire will progress with their own decision. | |

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| | |MM |

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|(e) |NHS Scotland Valproate Patient Safety Alert | |

| |There was discussion by a number of ADTC members about how they are taking this forward. It is anticipated that Mrs Gilmour| |

| |will be leading and coordinating NHS Lanarkshire wide response and Mr Lindsay will clarify with Mrs Gilmour that this is | |

| |indeed the case. |GL |

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|(f) |Acetylcysteine in Paracetamol Overdose | |

| |Doctor Malekian confirmed that he had signed off the requisite forms. This item can be removed from the Agenda. | |

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| |What’s the right Medicine for Me Video | |

| |Mr Lindsay confirmed that he had had discussions with Craig McKay in Communications who agreed to communicate these videos | |

|(g) |via Twitter and FaceBook. | |

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|(h) | | |

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| | |GLCG |

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|(i) | | |

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|(j) | | |

|2017/090 |SMC NEW Submissions – Confidential until Monday 10 July 2017 | AM |

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| |FULL SUBMISSIONS | |

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| |Nivolumab (Opdivo®) (No.1240/17) | |

| |This was noted and feedback will come from the West of Scotland Cancer Network. | |

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| |Selexipag (Uptravi®) (No 1235/17) | |

| |This was noted. | |

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| |Pembrolizumab (Keytruda®) (No.1239/17) | |

| |This was noted and feedback will come from the West of Scotland Cancer Network. | |

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| |Ustekinumab (Stelara®) (No.1250/17) | |

| |This was noted and will be referred to Gastroenterology specialists. | |

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| |ABBREVIATED SUBMISSIONS    | |

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| |Aprepitant (Emend®) (No.1252/17) | |

| |This was noted. | |

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| |Dolutegravir (Tivicay®) (No.1253/17) | |

| |This was noted. | |

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| |Glycopyrronium bromide (Sialanar®) (No.1254/17) | |

| |This was noted and will be referred to specialists in Paediatrics. | |

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| |Saxagliptin/dapagliflozin fixed dose combination (Qtern®) (No.1255/17) | |

| |This was noted and feedback will come from the Lanarkshire Diabetes Managed Clinical Network (MCN). | |

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| |Ciprofloxacin 3mg/mL/ dexamethasone 1mg/mL ear drops (Cilodex®) (No.1256/17) | |

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| |This was noted and will be referred to Ear, Nose and Throat (ENT) specialists | |

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| |NON SUBMISSIONS | |

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| |Emtricitabine / tenofovir disoproxil 200mg/245mg film-coated tablets (Truvada®) (No.1263/17) | |

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| |This was noted. | |

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| |Trametinib 0.5mg, 2mg film-coated tablets (Mekinist®) (No.1264/17) | |

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| |This was noted. | |

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| |AMENDED ADVICE | |

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| |Deferasirox 90mg, 180mg and 360mg film-coated tablets (Exjade®) (No.1246/17) | |

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| |This was noted. | |

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| |Obeticholic acid, 5mg and 10mg film-coated tablets (Ocaliva®)  (No.1232/17) | |

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| |This was noted. | |

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| |Aprepitant 80mg, 125mg hard capsules and 125mg powder for oral suspension (Emend®) (No.1241/17) | |

| |This was noted. | |

|2017/091 |SMC follow-up |AM |

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| |Mrs Milne talked the committee through the SMC follow-up which had been previously circulated. | |

|2017/092 | Lanarkshire formulary |AM |

|a. |Mrs Milne described the formulary amendment to add Ursodeoxycholic acid. This was approved by the committee. | |

|b. |Additional formulary prescribing notes for Anxiety Disorders, highlighting services such as Beating the Blues (an online CBT| |

| |programme), were approved for inclusion by the ADTC. | |

|c. |The new medicines decisions for June 2017 was noted. | |

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|2017/093 |Clinical Protocols | |

| |There was nil to note | |

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|2017/094 |ADTC Bulletin | |

| |This was covered under item 6c | |

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|2017/095 | Unlicensed Medicines | |

| |There was nil to note at this meeting. | |

|2017/096 |NICE/HIS Guidance | |

| |There was nil to note at this meeting. | |

|2017/097 |Medication and Clinical Risk in Lanarkshire | |

| |This was noted. | |

|2017/098 |Regional Cancer Advisory Network | |

| |Mr Milne gave a full report on plans in place to incorporate the treatment of adverse effects due to Immunosuppressant | |

| |therapies. This involves a broad number of stakeholders in Primary and Secondary Care and a wide variety of education | |

| |techniques. It was clear than an extensive plan is in place and is moving towards implementation. Mr Milne will keep us | |

| |informed. | |

| | |JM |

|2017/099 |Patient Safety Alerts | |

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| |There was nil additional to note at this meeting. | |

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|2017/100 |Lay Member Related Items | |

| |There was nil to note at this meeting. | |

|2017/101 |Correspondence | |

|(i) |New updated EAMS Guidance for Glecaprevir. Dr Dundas undertook to ensure that Dr Kennedy was aware of this and Mrs | |

| |Richardson similarly undertook to ensure that Ms Kathleen Macarthur from Pharmacy was aware of this. | |

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| |NHS Biosimilar Update |SD/GR |

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|(ii) | | |

| |This was noted | |

|(iii) |Updated version of the National Clinical Guideline on treatment of HCV in adults | |

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| |This was noted | |

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| |Palliative Care | |

|(iv) |SC Administration of medications by patients and Informal Carers | |

| |In Miss Johnstone’s absence, Mr Lindsay was able to report that Ms Johnstone was working with the Palliative Care MCN to | |

| |take this issue forward. It will also be done in collaboration with Mrs Anne Armstrong and Mrs Maria Docherty, senior | |

| |nurses for North and South Health and Social Care Partnerships. The anticipation is that the next version will go to the | |

| |Palliative Care MCN on 7 September 2017 and to the ADCT thereafter. | |

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| |Formulary Amendment Request | |

| | |LJ |

|2017/102 |The formulary amendment request for Dihydrocodeine was discussed. The decision was: | |

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| |This will not be added to the Formulary, | |

| |There will be discouragement of using Dihydrocodeine save in exceptional circumstances and | |

| |If these exceptional circumstances arise then communication to Primary Care should clarify that treatment should last for a | |

| |limited time [supplied from the Acute Service with no ongoing treatment being supplied from Primary Care] and the reasons | |

| |for the exceptional circumstances. | |

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| |Dr Malekian will feed this back to the relevant Consultant and Pharmacist | |

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| |Any Other Business | |

| |There was no other competent business at this meeting | |

| | |MM |

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|2017/103 | | |

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|2017/104 |Date of Next Meeting | |

| |The next scheduled meeting is on Wednesday 19 July 2017 at 10am in the Board Room, Kirklands Hospital. However it is | |

| |recognised that a high proportion of members may be on holiday. Dr Malekian is going to poll member of the ADCT to check | |

| |whether or not we will be quorate on that day and if not the meeting will be postponed with the next meeting taking place in| |

| |August. | |

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| | |MM |

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