8.2.5. Immunomodulating drugs used in Multiple Sclerosis
Prescribing Notes:
- Use for adults with relapsing-remitting multiple sclerosis (RRMS) with active disease is restricted to specialist use only.
Restrictions:
Restricted to specialist use in patients with rapidly evolving severe relapsing-remitting Multiple Sclerosis (MS) in accordance with local guidelines in the following subgroups:
- Patients with two or more relapses in the prior year whether on treatment or not, and at least one T1 gadolinium-enhancing lesion.
- Patients with sub-optimal therapy relapsing-remitting MS (defined as patients with one or more relapses in the previous year while on disease modifying therapy, and at least one T1 gadolinium-enhancing lesion or nine T2 lesions).
Restrictions:
Restricted to specialist use for the treatment of relapsing remitting multiple sclerosis in accordance with local guidelines.
Restrictions:
The treatment of adult patients with relapsing remitting multiple sclerosis is restricted to specialist use in accordance with local guidelines.
Restrictions:
Restricted to specialist use in accordance with local protocol for the treatment of walking disability associated with multiple sclerosis.
Restrictions:
Use is restricted in accordance to prescribing notes below.
Prescribing Notes:
Use as a single therapy in highly active relapsing remitting multiple sclerosis (RRMS) is restricted to use in the following adult patient groups:
- Patients with high disease activity despite treatment with at least one disease modifying therapy
- Patients with rapidly evolving severe relapsing remitting multiple sclerosis (defined by two or more disabling relapses in one year, and with one or more Gadolinium enhancing lesions on brain MRI or a significant increase in T2 lesion load as compared to a previous recent MRI.)
Restrictions:
Restricted to specialist use only. Restricted to use under the provision of the ‘Risk Sharing Scheme’ between the Scottish Executive Health Department and the manufacturers (NHS HDL (2002)6).
Restrictions:
Restricted to specialist use only. Restricted to use under the provision of the ‘Risk Sharing Scheme’ between the Scottish Executive Health Department and the manufacturers (NHS HDL (2002)6). Treatment of a single demyelinating event with an active inflammatory process has not been accepted by SMC and is non-Formulary.
Restrictions:
Restricted to specialist use only. Restricted to specialist use in accordance with agreed local protocol and SMC restrictions. Use of natalizumab as a single disease modifying therapy in highly active relapsing remitting multiple sclerosis (RRMS) is not recommended for use by the Scottish Medicines Consortium and is non-Formulary.
Restrictions:
Primary Progressive Multiple Sclerosis (PPMS):
- The treatment of early progressive multiple sclerosis (PPMS) is restricted to specialist use in accordance with local guidelines.
Relapsing-Remitting Multiple Sclerosis (RRMS):
- Restricted to specialist use in accordance with local guidelines for the treatment of remitting-relapsing multiple sclerosis (RRMS) in adults with active disease defined by clinical or imaging features who are contra-indicated or otherwise unsuitable for alemtuzumab.
Restrictions:
Restricted to specialist use for the treatment of relapsing-remitting multiple sclerosis (RRMS) with active disease defined by clinical or imaging features in accordance with local protocol (in development).
Prescribing Notes:
Ofatumumab is available for use in the same positioning of the treatment pathway as ocrelizumab.
Restrictions:
Treatment of adult patients with relapsing remitting multiple sclerosis (RRMS) with active disease as defined by clinical or imaging features is restricted to specialist use in patients suitable for, or requesting an oral treatment
Restrictions:
Restricted to specialist use for the treatment of relapsing remitting multiple sclerosis in adults.
Restrictions:
Restricted to specialist use in accordance with local guidelines in patients with relapsing-remitting multiple sclerosis (RRMS) with active disease defined by clinical or imaging features, suitable for or requesting an oral treatment.
Restrictions:
Restricted to specialist use in accordance with local guidelines for the treatment of adults with secondary progressive multiple sclerosis (SPMS) with active disease evidenced by relapses or imaging features of inflammatory activity
Restrictions:
The treatment of adults with relapsing remitting multiple sclerosis (MS) is restricted to specialist use as an alternative to treatment with interferon beta or glatiramer acetate. Teriflunomide is not expected to be used for the treatment of patients with highly active disease.