• Approved for the treatment of moderate to severe rheumatoid arthritis in adults in line with NICE.
• Approved for use in monogenic interferonopathis in adults and children 2 years and over in line with NHS England Clinical Commissioning Policy.

• Approved for treating moderate to severe rheumatoid arthritis in line with NICE

• 5mg and 10mg tablets.
• Approved for treating junveline idiopathic arthritis in line with NICE
• Approved for the treatment of active psoriatic arthritis after inadequate response to DMARDs in line with NICE.
• Approved for the treatment of moderate to severe rheumatoid arthritis in adults in line with NICE.
• Approved for for treating active ankylosing spondylitis in line with NICE

• Only approved for use in patients with rheumatoid arthritis who are unable to tolerate biologics and other DMARDs.

• See section 8.2.1

• See section 8.2.2

• See section 8.1.3
• 2.5mg tablets
• MHRA Drug Safety Update (Sept 2020): Methotrexate once-weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly dosing

• Capsules: 250mg 
• Tablets: 500mg 
• MHRA Drug Safety Updates

• Abatacept 250mg injection is approved for:
  • Juvenile idiopathic arthritis in patients aged six years and above (licensed) and under six years. It should only be prescribed with informed consent.
  • People aged 6 years and older to treat polyarticular juvenile idiopathic arthritis (JIA) whose diease has responded inadequately to other DMARDs, including at least one tumour necrosis factor (TNF) inhibitor in accordance with NICE.
  • Rheumatoid arthritis after the failure of a TNF inhibitor in line with NICE.
  • Treatment in adults with severe rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed in accordance with NICE.
  • Treatment of severe treatment-resistant morphoea in line with NHS England Clinical Commissioning Policy
  • Treating modertae rheumatoid arthritis after conventional DMARDs have failed in line with NICE
  • Treating idiopathic inflammatory myopathies in adults and children aged 2 and over in line with NHS England Commissioning Policy
• Abatacept 125mg SC injection (prefilled syringe) is approved for moderate to severe rheumatoid arthritis in accordance with NICE.

• Adalimumab is approved for:
• The treatment of adults with severe rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed in accordance with NICE 
• Rheumatoid arthritis after the failure of a TNF inhibitor in accordance with NICE.
• Treatment of severe active ankylosing spondylitis in adults whose disease has responded inadequately to, or who cannot tolerate, non-steroidal anti-inflammatory drugs in accordance with NICE.
• Psoriatic arthritis in accordance with NICE.
• As a second-line anti-TNF therapy in children with juvenile idiopathic arthritis and uveitis.
• Children and adults aged 2 years and older to treat polyarticular juvenile idiopathic arthritis (JIA) whose disease has responded inadequately to 1 or more DMARD in accordance with NICE.
• Treating moderate rheumatoid arhritis after conventional DMARDs have failed in line with NICE

• Approved for:
  • Juvenile Idiopathic Arthritis (JIA) in line with NICE and NHS England Clinical Commissioning Policy: E03/P/d
  • Periodic Fevers and Autoinflammatory conditions in line with NHS England Clinical Commissioning Policy: 170062P
  • Adult‑onset Still’s disease and systemic juvenile idiopathic arthritis in people 8 months and older in line with NICE
  • Cryopyrin Associated Periodic Syndrome in line with NHSE Service Specification. 
  • The treatment of severe gout in patients who have not responded to other treatment and for patients with pseudogout who have failed to respond to conventional treatment or unable to tolerate conventional treatment.
  • Chronic Infantile Neurocutaneous Arthritis (CINCA) and Muckle-Wells Syndrome (unlicensed indications).
  • Islet cell transplantation as part of a protocol including alemtuzumab and etanercept to improve outcomes (i.e. insulin dependance)
  • Haemophagocytic Lymphohistiocytosis (HLH) for adults and children in all ages

• Approved for the treatment of psoriatic arthritis in line with NICE

• Approved for treating active autoantibody-positive systemic lupus erythematosus in line with NICE

• 160mg/1ml solution for injection - pre-filled pen and syringes
• Approved for the treatment of active psoriatic arthritis in line with NICE
• Approved fofr the treatment of axial spondyloartritis in line with NICE

• Approved for:
  
  • Adults with severe rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed in accordance with NICE.
  • Rheumatoid arthritis after inadequate response to a TNF-alpha inhibitor in accordance with NICE.
  • Severe active ankylosing spondylitis in adults whose disease has responded inadequately to, or who cannot tolerate, non-steroidal anti-inflammatory drugs in accordance with NICE.
  • Psoriatic arthritis in accordance with NICE.
  
  

Prescribe by brand name.

• Approved formulations include 10mg (Enbrel®) 25mg injection (Enbrel®, Benepali® & Erelzi®), 50mg injection (Enbrel®, Benepali® & Erelzi®). 
• Approved for:
  
  • Treatment in adults with severe rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed in line with NICE.
  • Rheumatoid arthritis after the failure of a TNF inhibitor in line with NICE.
  • Psoriatic arthritis in accordance with NICE.
  • Treatment of severe active ankylosing spondylitis in adults whose disease has responded inadequately to, or who cannot tolerate, non-steroidal anti-inflammatory drugs in accordance with NICE.
  • The treatment of juvenile idiopathic arthritis (JIA) in people 2 years or older whose disease has responded inadequately to, or who are intolerant of methotrexate in line with NICE.
  • Treatment of Juvenile Scleroderma (Its use will be subject to informed consent and specialists using etanercept in this indication should collect data on patient outcomes. If after a six month trial, treatment were found to be beneficial, it would be continued for two years. If unsuccessful after six months, treatment should be discontinued).
  • People aged 2 years and older to treat polyarticular juvenile idiopathic arthritis (JIA) whose diease has responded inadequately to, or who are intolerant of methotrexate in line with NICE.
  • Treating moderate rheumatoid arthritis after conventional DMARDs have failed in line with NICE
  
  
  

• Approved for:
  
  • Rheumatoid arthritis in accordance with NICE.
  • Psoriatic arthritis in accordance with NICE.
  • The treatment of severe active ankylosing spondylitis in adults whose disease has responded inadequately to, or who cannot tolerate, non-steroidal anti-inflammatory drugs in accordance with NICE.
  • Treatment in adults with severe rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed in accordance with NICE.
  • The treatment of non-radiographic axial spondyloarthritis in accordance with NICE

• 100 mg/1 mL as a pre-filled syringe
• Approved (alone or with methotrexate) for treating active psoriatic arthritis after inadequate response to DMARDs in line with NICE

Overview | Guselkumab for treating active psoriatic arthritis after inadequate response to DMARDs | Guidance | NICE

• Approved for:
  
  • Treatment in adults with severe rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs have failed in accordance with NICE.
  • Rheumatoid arthritis after the failure of a TNF inhibitor in line with NICE.
  • Psoriatic arthritis in accordance with NICE.
  • JIA in patients who have not responded to etanercept.
  • Juvenile dermatomyositis and paediatric onset Behcet’s disease where there has been intolerance or lack of response to 1st and 2nd line therapies.
  • The treatment of severe active ankylosing spondylitis in adults whose disease has responded inadequately to, or who cannot tolerate, non-steroidal anti-inflammatory drugs in accordance with NICE.
  • Treating moderate rheumatoid arthritis after conventional DMARDs have failed in line with NICE
  • Refractory sarcoidosis (excluding neurosarcoidosis) in adults in line with NHSE Specialised Commissioing Policy 
  
  
  
• Prescribe by brand name; Remsima®, Inflectra®, Remicade®. 

• 80mg/ml pre-filled syringe or pen
• Approved for the treatment of axial spondyloarthritis in line with NICE
• Approved for the treatment of active psoriatic arthritis after inadequate response to DMARDS
  
  

• Approved for:
  
  • Adults with severe systemic lupus erythematosus who have failed conventional therapies.
  • Rheumatoid arthritis after the failure of a TNF inhibitor in line with NICE.
  • Combination with methotrexate as first-line biological therapy in cases where there is an absolute contraindication to tumour necrosis factor inhibitors (NETAG approval).
  • Combination with other (non-methotrexate) disease modifying antirheumatic drugs and as monotherapy in cases in which conventional treatment with tumour necrosis factor inhibitors or methotrexate is deemed unsafe (NETAG approval).
  • For immunoglobulin G4-related disease (IgG4-RD) in accordance with NHS England Commissioning Criteria
  • Myositis in accordance with NHS England Commissioning Criteria
  • Juvenile Idiopathic Arthritis (JIA) in accordance with NHS England Commissioning Criteria

• 150mg/1.14mL & 200mg/1.14mL injection


• Approved as an option for treating active rheumatoid arthritis in adults whose disease has responded inadequately to intensive therapy with a combination of conventional disease-modifying antirheumatic drugs (DMARDs) in line with NICE

• Approved for active ankylosing spondylitis in line with NICE.
• Approved for psoriatic arthritis in line with NICE.
• Approved for the treatment of non-radiographic axial spondyloarthritis in line with NICE

• IV preparations approved for:
  
  • Systemic JIA in children and young people aged 2 years and older in line with NICE.
  • People aged 2 years and older to treat polyarticular juvenile idiopathic arthritis (JIA) whose diease has responded inadequately to previous therapy with methotrexate in line with NICE.
  • An alternative treatment to anakinra for patients with systemic onset JIA who have already received treatment with etanercept and adalimumab (NETAG approval). Not recommended for polyarticular JIA.
  • Rheumatoid arthritis in accordance with NICE.
  • Treatment in adults with severe rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed in accordance with NICE.
• 162mg SC injection is approved for:
  
  • Rheumatoid arthritis in accordance with NICE.
  • Giant cell arteritis in adults only if:
    
    • they have relapsing or refractory disease
    • they have not already had tocilizumab
    • tocilizumab is stopped after 1 year of uninterrupted treatment at most.
• Monitoring: monitoring of tocilizumab in adult patients can be undertaken by GPs under a shared care arrangement

• Approved for the treatment of severe active rheumatoid arthritis in adults in line with NICE.
• Approved for the treatment of moderate rheumatoid arthritis in line with NICE.
• Approved for the treatment of active psoriatic arthritis after inadeqaute response to DMARDs in line with NICE.

• Approved for psoriatic arthritis in accordance with NICE.