Microsoft word - 137_tas_minutes-26-02-13.doc

MINUTES OF THE 137th MEETING OF THE
THERAPEUTIC ADVISORY SERVICE
Held on Tuesday, 26th February 2013
Apologies: Prof I Squire, Ms C Clarke, Dr L Dabydeen, Mr P Golightly, Dr P Topham, Dr A
Palfreeman, Mr M Qualie, Dr B Collett, Ms L Gant, Mr D Harris, Ms J Islam, Mrs S Khalid

1
Minutes of last Meeting Dr N Langford and Ms B Pattani attended, with
these additions Minutes approved
Matters arising
Dabigatran / Rivaroxaban update
Members were given an update on the managed entry progress for these
drugs. It was also noted that the FAD for apixaban supports use. Stroke and
haematology consultants reported that they had identified small numbers of
patients who would benefit from use who currently were not included in local
criteria. It was agreed that an “other” box should be included on the new drug
forms with justification required. However this should only include NICE
criteria at present. Local guidance and potential recommended choices will
be updated when audit data is supplied and reviewed.
A request from Dr Strong to extend prescribing to nurse prescribers in the
DVT clinic was not supported until there is more experience of use / traffic
light status moves to green.
Action: Subject to LMSG endorsement KC to amend forms and advise
approved prescribers. KC to feedback to Dr Strong

Pramipexole SR audit
Members had requested more data on outcome measures and benefits but
feedback from neurology is that this data is not recorded routinely. Members
noted that cost differential between standard and sustained release products
could be up to £2000 per annum per patient and as 24 patients were
prescribed the SR product in a 6/12 period this has a substantial cost impact.
The committee needs to be reassured that benefits are being realised. It was
agreed that prospective audit should take place with a baseline assessment of
symptoms and review to show changes using e.g. an appropriate Parkinson’s
disease assessment tool.
TAS Decision: Further information required as detailed
Action: KC to advise Dr Critchley
Salofalk granules audit
Members had requested further details of outcome measures from Professor
Jankowski. He has advised that he is no longer in a position to collect this
data. Dr DeCaestecker has reported that Salofalk granules are being used
and effective and have a lower cost than the previously used product,
Pentasa. Members agreed that it was appropriate to continue use without
further audit.
Action: KC to feedback to GI consultants and reinforce formulary
choices
New Product Requests

8Y factor VIII for TTP requested by Dr Gooding (Consultant
Haematologist) Members noted that although evidence is limited to case
reports, outcomes were positive without adverse effects. Shorter duration
time for administration and possibility of home administration would be a
significant benefit to the patient. Governance issues of homecare would need
to be acceptable to the homecare team
TAS decision: Supported for use subject to homecare team assessment

Action: KC to advise requestor, CBU lead and homecare pharmacist
For a full review of this product and supporting papers relating to this submission visit
www.tas-leicester.org
Tocilizumab (without methotrexate) for Rheumatoid Arthritis requested
by Dr Kinder (Consultant Rheumatologist)
Members noted that since a negative verdict by NICE TA247, trials have been
undertaken which show efficacy in patients who were intolerant to
methotrexate or where continued use of methotrexate is inappropriate. The
SMC has also supported use and it has been confirmed that patient access
scheme conditions will also apply to this indication
TAS decision: Supported for use as above
Action: KC to advise requestor and liaise with CCGs for funding support
For a full review of this product and supporting papers relating to this submission visit www.tas-
leicester.org
Fampridine for Multiple Sclerosis requested by Dr Nikfekr (Consultant
Neurologist). Members agreed that that the evidence for efficacy was very
limited even in the third of patients who responded to treatment. Side effects
of note included falls, insomnia and fatigue and those causing discontinuation
of treatment in one study included ankle fracture, balance disorder
confusional state and dizziness.

TAS decision: Not supported for use
Action: NL to advise requestor
For a full review of this product and supporting papers relating to this submission visit www.tas-
leicester.org
Dexmedetomidine for sedation in one child requested by Mr Peek. A full application has been requested Rituximab in ILD requested by due to dermatomyositis requested by Dr Amikacin eye drops for atypical mycobacterial keratitis requested by Mr Savant. A full application has been requested Members endorsed the Chairman’s action to support the above in one patient only Recent NICE Guidance
TA 271 Diabetic macular oedema: Fluocinoone acetonide intravitreal implant. Not supported by NICE, not currently used at UHL TA 272 Urothelial tract carcinoma: vinflunine, not recommended. Not used at UHL TA 273 Hyperplasia (benign prostatic) – tadalafil (terminated appraisal). Not used at UHL TAS decision for above: Not supported for use Outstanding TAs: the only NICE TAs where drugs are not currently in use at
UHL are TA 157/170/245 dabigatran, rivaroxaban and apixaban for use post
hip and knee surgery.
Use of abatacept as part of TA 195 will be reviewed when NICE produces
further
TAS Audit
Wilate (Dr Pavord): Members acknowledged submission of audit data for 2
patients where this has been used and asked that audit data continues to be
collected over the next 12 months in order to assess more fully
Action: KC to advise Dr Pavord

Eczmol (Dr Alexandroff): Members noted that where use was in line with TAS
approval outcomes were positive in 80% of cases. There had been
considerable use outside of approved indications and outcomes were much
poorer. Use should be within in the approved indications only and further
audit data is required in 6 months.
Action:
Alexandroff
Acenocoumarol ( Salinder Gill) Members noted that use was appropriate and
as anticipated with good outcomes
No further action required

MHRA Drug Safety Updates January 13 – suggested actions accepted. AOB
Terms of Reference
Minor changes accepted
Action: KC to forward to Medicines Management Board /LMSG for
endorsement
Date and Time of Next Meeting
Date: 16th April 2013
Time: 4pm
Place: Beech Room Knighton Street Office, LRI

Source: http://leicestershire.formulary.co.uk/docs/137TASMinutes260213.pdf