Ciclosporin - Inflammatory bowel disease

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve the RMOC national shared care protocol with ‘local adaptations’.

This shared care protocol applies to adults aged 18 and over.

The local adaptation excludes gastroenterology indications from shared care, as it is considered a short-term treatment requiring hospital led treatment, and therefore a RED traffic light status, and this is endorsed by the Surrey Heartlands clinicians. All other indications listed in the shared care document will be considered AMBER

This shared care protocol also includes treatment of chronic inflammatory conditions where off-label use of ciclosporin is appropriate, including, but not limited to, the specialities and conditions described in Section 3 of the document.

These indications are off-label. The specialist must specify the indication for each patient when initiating shared care and clearly state when use is off-label.

The PCN recommend the use of Infliximab, Adalimumab and Golimumab in line with NICE TA329 and a treatment pathway is attached which has been developed with local specialists. Aminosalicylates and Thiopurines are included in the pathway as treatment options.

It was noted that ciclosporin is only used in a small number of IBD patients and that these patients are generally very unwell and therefore are regularly reviewed by secondary care. It was noted that ciclosporin is usually only given for 3-6 months and is not ongoing in this patient cohort. During this time period they are monitored closely by secondary care. It was therefore felt that it would be inappropriate to have a shared care for ciclosporin for IBD.